Provider Demographics
NPI:1669439337
Name:MARTIN, LOUISA EILEEN (PMHCNS-BC)
Entity Type:Individual
Prefix:
First Name:LOUISA
Middle Name:EILEEN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:LOUISA
Other - Middle Name:EILEEN
Other - Last Name:SCHLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:210 BEAR HILL RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1023
Mailing Address - Country:US
Mailing Address - Phone:781-966-0070
Mailing Address - Fax:781-915-0755
Practice Address - Street 1:210 BEAR HILL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1023
Practice Address - Country:US
Practice Address - Phone:781-966-0070
Practice Address - Fax:781-915-0755
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238093364S00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0751Medicare ID - Type Unspecified