Individual
MARTHA D'ILIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
92 SWEET BAY TRL, PETAL, MS 39465-9463
(601) 270-5343
Mailing address
92 SWEET BAY TRL, PETAL, MS 39465-9463
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
31-462
MS
Other
Enumeration date
10/19/2016
Last updated
10/19/2016
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