Provider Demographics
NPI:1710272380
Name:KRUGMAN, MARTIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:KRUGMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 STONE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5039
Mailing Address - Country:US
Mailing Address - Phone:978-857-8397
Mailing Address - Fax:978-927-1860
Practice Address - Street 1:32 STONE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5039
Practice Address - Country:US
Practice Address - Phone:978-857-8397
Practice Address - Fax:978-927-1860
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6757103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist