Provider Demographics
NPI:1598979346
Name:MARTINI, PATRICIA ANN (MA LP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:MARTINI
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:GALEN
Other - Middle Name:A
Other - Last Name:MARTINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LP
Mailing Address - Street 1:502 WEST MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:ST JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374
Mailing Address - Country:US
Mailing Address - Phone:320-363-4394
Mailing Address - Fax:
Practice Address - Street 1:100 WEST MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:ST JOSEPH
Practice Address - State:MN
Practice Address - Zip Code:56374
Practice Address - Country:US
Practice Address - Phone:320-363-7163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102L00000X
MNLP3796103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN44B47MAOtherBLUE CROSS BLUE SHIELD MN