Provider Demographics
NPI:1477719367
Name:DAMEK, MARTHA JO (MED)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:JO
Last Name:DAMEK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10520 E CAMINO QUINCE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-6811
Mailing Address - Country:US
Mailing Address - Phone:520-731-5400
Mailing Address - Fax:520-731-5401
Practice Address - Street 1:10520 E CAMINO QUINCE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-6811
Practice Address - Country:US
Practice Address - Phone:520-731-5400
Practice Address - Fax:520-731-5401
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool