Provider Demographics
NPI:1588671218
Name:MARTIN, DONNA M (PSYD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
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 1:334 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1273
Mailing Address - Country:US
Mailing Address - Phone:215-536-0206
Mailing Address - Fax:215-536-3596
Practice Address - Street 1:334 W BROAD ST
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1273
Practice Address - Country:US
Practice Address - Phone:215-536-0206
Practice Address - Fax:215-536-3596
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015577103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA1673293OtherBLUESHIELD
PA786318000OtherMAGELLAN BEHAVIORAL HEALT
PA087368FJ1Medicare ID - Type Unspecified