Provider Demographics
NPI:1053452672
Name:RICH, MARTINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTINA
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2315
Mailing Address - Country:US
Mailing Address - Phone:801-581-6228
Mailing Address - Fax:801-585-6702
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:1R52 SOM
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2119
Practice Address - Country:US
Practice Address - Phone:801-581-6228
Practice Address - Fax:801-585-6702
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT369755-2501103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)