Provider Demographics
NPI:1114377967
Name:POND, MARTHA A
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:A
Last Name:POND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2183
Mailing Address - Country:US
Mailing Address - Phone:774-633-6832
Mailing Address - Fax:208-977-4399
Practice Address - Street 1:57 CEDAR ST
Practice Address - Street 2:WORCESTER
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2183
Practice Address - Country:US
Practice Address - Phone:774-633-6832
Practice Address - Fax:208-977-4399
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2374101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)