Provider Demographics
NPI:1417002015
Name:GALLEGO ADKINS, MARTA ISABEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:ISABEL
Last Name:GALLEGO ADKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARTA
Other - Middle Name:ISABEL
Other - Last Name:GALLEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1454 MADISON AVE W
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2200
Mailing Address - Country:US
Mailing Address - Phone:239-658-3000
Mailing Address - Fax:
Practice Address - Street 1:12655 COLLIER BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-4005
Practice Address - Country:US
Practice Address - Phone:239-658-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002105103T00000X
FLPY 6135103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54617OtherBLUE CROSS
FL54617ZMedicare ID - Type UnspecifiedGROUP MEDICARE