Individual
MARY ANNE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
216 LAFAYETTE ST, SCHENECTADY, NY 12305-2408
(518) 243-3300
(518) 377-9151
Mailing address
1462 ERIE BLVD, SUITE 2, SCHENECTADY, NY 12305-1026
(518) 243-1500
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
400240
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000408304001
BLUE CROSS
NY
01
—
050322000010
FIDELIS
NY
01
—
11488383
CAQH
NY
01
—
4129368
MVP
NY
Enumeration date
12/23/2005
Last updated
01/29/2020
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