Organization
MARY KATHLEEN MARTIN NURSE PRACTITIONER IN PSYCHIATRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY MARTIN NP (OWNER)
(631) 766-3210
Entity
Organization
Contact information
Practice address
21 W 2ND ST, SUITE 11, RIVERHEAD, NY 11901-2752
(631) 624-7839
(631) 865-5857
Mailing address
375 W MILL RD, MATTITUCK, NY 11952-2079
(631) 766-3210
(631) 865-5857
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
401909
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13554525
CAQH
NY
Enumeration date
02/04/2016
Last updated
02/04/2016
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