Provider Demographics
NPI:1669824702
Name:MARTIN D OLIVEIRA PSY D LLC
Entity Type:Organization
Organization Name:MARTIN D OLIVEIRA PSY D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-519-5227
Mailing Address - Street 1:14 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2719
Mailing Address - Country:US
Mailing Address - Phone:860-519-5227
Mailing Address - Fax:845-728-0667
Practice Address - Street 1:10 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1968
Practice Address - Country:US
Practice Address - Phone:860-519-5227
Practice Address - Fax:845-728-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002930103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty