Provider Demographics
NPI:1063034395
Name:MARTIN PSYCHOLOGICAL SERVICES & CONSULTING, LLC
Entity Type:Organization
Organization Name:MARTIN PSYCHOLOGICAL SERVICES & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:727-755-1851
Mailing Address - Street 1:2565 DEER RUN E
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3902
Mailing Address - Country:US
Mailing Address - Phone:419-509-9023
Mailing Address - Fax:
Practice Address - Street 1:2565 DEER RUN E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3902
Practice Address - Country:US
Practice Address - Phone:419-509-9023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty