Individual
DR. JOHNATHAN MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1970 ROANOKE BLVD, SALEM VA MEDICAL CENTER, SALEM, VA 24153-6404
(540) 982-2463
Mailing address
1970 ROANOKE BLVD, SALEM VA MEDICAL CENTER, SALEM, VA 24153-6404
(540) 982-2463
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810005692
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/18/2016
Last updated
05/15/2017
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