Individual
MARY MARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
102 MARTY DR, BUFFALO, MN 55313
(763) 682-5420
(763) 682-5803
Mailing address
102 MARTY DR, BUFFALO, MN 55313
(763) 682-5420
(763) 682-5803
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3295
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007832
PREFERRED ONE
MN
01
—
110564
UCARE
MN
01
—
62-00625
MEDICA
MN
01
—
67D67MA
BLUE CROSS BLUE SHIELD
MN
01
—
HP18920
HEALTHPARTNERS
MN
Enumeration date
09/21/2006
Last updated
07/08/2007
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