Provider Demographics
NPI:1326285149
Name:TAYLOR, MARTINA MADGE
Entity Type:Individual
Prefix:MS
First Name:MARTINA
Middle Name:MADGE
Last Name:TAYLOR
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 1:665 PELHAM PKWY N
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8068
Mailing Address - Country:US
Mailing Address - Phone:718-519-8326
Mailing Address - Fax:718-881-8714
Practice Address - Street 1:665 PELHAM PKWY N
Practice Address - Street 2:SUITE 402
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8068
Practice Address - Country:US
Practice Address - Phone:718-519-8326
Practice Address - Fax:718-881-8714
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health