Provider Demographics
NPI:1407071731
Name:MARTIN, CHARLES ROCHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROCHELLE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 NW 43RD ST
Mailing Address - Street 2:E-4
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8137
Mailing Address - Country:US
Mailing Address - Phone:352-375-7756
Mailing Address - Fax:
Practice Address - Street 1:3600 NW 43RD ST
Practice Address - Street 2:SUITE E-4
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-8137
Practice Address - Country:US
Practice Address - Phone:352-375-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5214103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling