Provider Demographics
NPI:1629730692
Name:MARTIN, CYRENA
Entity Type:Individual
Prefix:
First Name:CYRENA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8292 N 61ST ST
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-3562
Mailing Address - Country:US
Mailing Address - Phone:262-993-5444
Mailing Address - Fax:
Practice Address - Street 1:1849 N MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3639
Practice Address - Country:US
Practice Address - Phone:414-347-1774
Practice Address - Fax:414-347-0148
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health