Provider Demographics
NPI:1568451227
Name:MARTIN, VIRGINIA CAROLYN (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:CAROLYN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 BINGHAM ST
Mailing Address - Street 2:FRANKLIN BUILDING, 1ST FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-1101
Mailing Address - Country:US
Mailing Address - Phone:412-235-5445
Mailing Address - Fax:412-235-5446
Practice Address - Street 1:1011 BINGHAM ST
Practice Address - Street 2:FRANKLIN BUILDING, 1ST FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-1101
Practice Address - Country:US
Practice Address - Phone:412-235-5445
Practice Address - Fax:412-235-5446
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016482103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent