Provider Demographics
NPI:1073145850
Name:PATRICIA MARTIN PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PATRICIA MARTIN PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-991-2632
Mailing Address - Street 1:800 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5126
Mailing Address - Country:US
Mailing Address - Phone:310-991-2632
Mailing Address - Fax:
Practice Address - Street 1:800 E HIGH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5126
Practice Address - Country:US
Practice Address - Phone:310-991-2632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty