Provider Demographics
NPI:1619261484
Name:MARTYNOWYCH, PETER (DOCTORATE)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:MARTYNOWYCH
Suffix:
Gender:M
Credentials:DOCTORATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9740 46TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2620
Mailing Address - Country:US
Mailing Address - Phone:206-985-1702
Mailing Address - Fax:
Practice Address - Street 1:2901 NE BLAKELEY ST
Practice Address - Street 2:SUITE 3B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3164
Practice Address - Country:US
Practice Address - Phone:206-605-0694
Practice Address - Fax:206-729-2636
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 00004740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health