Provider Demographics
NPI:1689736621
Name:AMERIKANER, MARTIN JOHN (PH D)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOHN
Last Name:AMERIKANER
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 10TH AVE W
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3106
Mailing Address - Country:US
Mailing Address - Phone:304-522-1921
Mailing Address - Fax:304-696-2784
Practice Address - Street 1:845 4TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1428
Practice Address - Country:US
Practice Address - Phone:304-523-8911
Practice Address - Fax:304-523-8912
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV449103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9201126000Medicaid