Provider Demographics
NPI:1144395625
Name:RITCHHART, MARTINA KATHLEEN (PHD)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:KATHLEEN
Last Name:RITCHHART
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 1:2907 WYE OAK DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-7038
Mailing Address - Country:US
Mailing Address - Phone:618-407-0672
Mailing Address - Fax:
Practice Address - Street 1:6500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3700
Practice Address - Country:US
Practice Address - Phone:800-228-5459
Practice Address - Fax:314-289-7660
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.006968103T00000X
AZ3629103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist