Provider Demographics
NPI:1699017210
Name:CRANOR, MARTHA P (PSYD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:P
Last Name:CRANOR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CUSHMAN ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4640
Mailing Address - Country:US
Mailing Address - Phone:907-457-2700
Mailing Address - Fax:907-457-2707
Practice Address - Street 1:250 CUSHMAN ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4640
Practice Address - Country:US
Practice Address - Phone:907-457-2700
Practice Address - Fax:907-457-2707
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA0225103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical