Provider Demographics
NPI:1538293055
Name:CARMODY, MARTHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:CARMODY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:CARMODY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:9600 TANOAN DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-5837
Mailing Address - Country:US
Mailing Address - Phone:505-822-0948
Mailing Address - Fax:
Practice Address - Street 1:121 WELLESLEY DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1443
Practice Address - Country:US
Practice Address - Phone:505-266-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM557103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist