Provider Demographics
NPI:1679037576
Name:FOUKAL, MARTHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:FOUKAL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:FOUKAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:8 BRADY DR
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-3928
Mailing Address - Country:US
Mailing Address - Phone:508-444-2910
Mailing Address - Fax:
Practice Address - Street 1:8 BRADY DR
Practice Address - Street 2:
Practice Address - City:EAST FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02536-3928
Practice Address - Country:US
Practice Address - Phone:508-444-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10952103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical