Provider Demographics
NPI:1568653020
Name:MARTIN, PETER E (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 SHERIDAN BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6100
Mailing Address - Country:US
Mailing Address - Phone:402-489-1834
Mailing Address - Fax:402-489-2046
Practice Address - Street 1:3700 SHERIDAN BLVD
Practice Address - Street 2:STE 1
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-6100
Practice Address - Country:US
Practice Address - Phone:402-489-1834
Practice Address - Fax:402-489-2046
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical