Provider Demographics
NPI:1053498386
Name:MARTINEZ THORNE, YVONNE (EDD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:
Last Name:MARTINEZ THORNE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8627 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2839
Mailing Address - Country:US
Mailing Address - Phone:610-304-4782
Mailing Address - Fax:484-231-8304
Practice Address - Street 1:34 E GERMANTOWN PIKE # 183
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1512
Practice Address - Country:US
Practice Address - Phone:610-304-4782
Practice Address - Fax:484-231-8304
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016085103TC0700X, 103TC1900X, 103TF0000X, 103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498389501Medicaid
MO498389501Medicaid
MOS70768Medicare UPIN