Provider Demographics
NPI:1710516489
Name:MARTIN, PETER (LMHC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 GROVE AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2302
Mailing Address - Country:US
Mailing Address - Phone:516-350-8564
Mailing Address - Fax:
Practice Address - Street 1:8675 MIDLAND PKWY STE 1
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3049
Practice Address - Country:US
Practice Address - Phone:516-350-8564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-05
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health