Provider Demographics
NPI:1366653214
Name:EIDMANN-HICKS, MARTHA JEAN (LMFT MDIV)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:JEAN
Last Name:EIDMANN-HICKS
Suffix:
Gender:F
Credentials:LMFT MDIV
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT MDIV
Mailing Address - Street 1:32 REVOLUTIONARY RD
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1448
Mailing Address - Country:US
Mailing Address - Phone:732-946-2877
Mailing Address - Fax:732-946-2877
Practice Address - Street 1:33 N MAIN ST
Practice Address - Street 2:WYCKOFF BUILDING
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1470
Practice Address - Country:US
Practice Address - Phone:732-834-9882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000663106H00000X
NJ37F100154700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist