Provider Demographics
NPI:1578646055
Name:SEYMOUR, MARTHA MARIE (NPP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MARIE
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 CENTER DRIVE 2ND FLOOR WING
Mailing Address - Street 2:RIVERHEAD MENTAL HEALTH CLINIC,COUNTY CENTER BUILDING
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-185-2144
Mailing Address - Fax:631-852-1448
Practice Address - Street 1:300 CENTER DRIVE 2ND FLOOR WING
Practice Address - Street 2:RIVERHEAD MENTAL HEALTH CLINIC,COUNTY CENTER BUILDING
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901
Practice Address - Country:US
Practice Address - Phone:631-185-2144
Practice Address - Fax:631-852-1448
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF400622-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health