Provider Demographics
NPI:1073756755
Name:EDWARDS, MARTHA EUGENIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:EUGENIA
Last Name:EDWARDS
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 1:149 E 78TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0405
Mailing Address - Country:US
Mailing Address - Phone:212-879-4900
Mailing Address - Fax:212-744-0206
Practice Address - Street 1:149 E 78TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0405
Practice Address - Country:US
Practice Address - Phone:212-879-4900
Practice Address - Fax:212-744-0206
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-11
Last Update Date:2009-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11507103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist