Provider Demographics
NPI:1568006203
Name:THOMAS R MARTIN MENTAL HEALTH COUNSELOR PLLC
Entity Type:Organization
Organization Name:THOMAS R MARTIN MENTAL HEALTH COUNSELOR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:845-868-4201
Mailing Address - Street 1:58 E ROUTE 59 STE 2
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2959
Mailing Address - Country:US
Mailing Address - Phone:845-868-4201
Mailing Address - Fax:
Practice Address - Street 1:58 E ROUTE 59 STE 2
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2959
Practice Address - Country:US
Practice Address - Phone:845-868-4201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty