Provider Demographics
NPI:1225145329
Name:MONAHAN, MARTHA (EDD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 WASHINGTON ST
Mailing Address - Street 2:SUITE 316
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3518
Mailing Address - Country:US
Mailing Address - Phone:978-745-5144
Mailing Address - Fax:978-741-8982
Practice Address - Street 1:70 WASHINGTON ST
Practice Address - Street 2:SUITE 316
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3518
Practice Address - Country:US
Practice Address - Phone:978-745-5144
Practice Address - Fax:978-741-8982
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6800103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA015589OtherPBH
MA1895010Medicaid
MAW05438OtherBCBS
MA42712OtherMAGELLAN
MA467505OtherTUFTS
MAW50003Medicare ID - Type Unspecified