Provider Demographics
NPI:1619034899
Name:FOSCHINI, MARTHA S (PHD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:S
Last Name:FOSCHINI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 UNION AVE
Mailing Address - Street 2:#315
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-726-1284
Mailing Address - Fax:901-726-4396
Practice Address - Street 1:1835 UNION AVE
Practice Address - Street 2:#315
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104
Practice Address - Country:US
Practice Address - Phone:901-726-1284
Practice Address - Fax:901-726-4396
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1038103TC0700X
AR0623P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3680665Medicare ID - Type Unspecified