Provider Demographics
NPI:1629086053
Name:SCHEIN, MARTHA A (PHD)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:A
Last Name:SCHEIN
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 1:503 WAIGHT ST
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-4344
Mailing Address - Country:US
Mailing Address - Phone:843-379-0644
Mailing Address - Fax:843-379-0644
Practice Address - Street 1:80 LADYS ISLAND DR
Practice Address - Street 2:SUITE D
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1643
Practice Address - Country:US
Practice Address - Phone:843-379-0644
Practice Address - Fax:843-379-0644
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002660103T00000X
SC1047103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA298207311AMedicaid
SCPS0434Medicaid
SC68BGBGJGMedicare UPIN
SCPS0434Medicaid