Provider Demographics
NPI:1760508097
Name:MARTINSEN, GWEN LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GWEN
Middle Name:LYNNE
Last Name:MARTINSEN
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 1:9424 BULLRING LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4409
Mailing Address - Country:US
Mailing Address - Phone:410-963-9670
Mailing Address - Fax:410-997-0675
Practice Address - Street 1:9424 BULLRING LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-4409
Practice Address - Country:US
Practice Address - Phone:410-963-9670
Practice Address - Fax:410-997-0675
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02637103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist