Provider Demographics
NPI:1710023676
Name:MARTIN, SUZANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7092 HARR AVE BLDG 6492
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80902-2190
Mailing Address - Country:US
Mailing Address - Phone:719-524-5217
Mailing Address - Fax:719-526-8883
Practice Address - Street 1:7092 HARR AVE BLDG 6492
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80902-2190
Practice Address - Country:US
Practice Address - Phone:719-524-5217
Practice Address - Fax:719-526-8883
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC6173-6Medicare ID - Type Unspecified