Provider Demographics
NPI:1346673084
Name:KIDD, MARTHA JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:JANE
Last Name:KIDD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:JANE
Other - Last Name:BRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:5605 CEDAR CREEK VW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-5026
Mailing Address - Country:US
Mailing Address - Phone:719-243-9771
Mailing Address - Fax:
Practice Address - Street 1:5605 CEDAR CREEK VW
Practice Address - Street 2:SUITE 101
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-5026
Practice Address - Country:US
Practice Address - Phone:719-243-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY0003901103T00000X
NC1097103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist