Provider Demographics
NPI:1760570998
Name:MARTINSEN, DELLA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:DELLA
Middle Name:A
Last Name:MARTINSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DELLA
Other - Middle Name:A
Other - Last Name:MCALLISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2116 4TH AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2967
Mailing Address - Country:US
Mailing Address - Phone:701-838-2112
Mailing Address - Fax:701-857-5031
Practice Address - Street 1:2116 4TH AVE NW
Practice Address - Street 2:STE # 100
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2967
Practice Address - Country:US
Practice Address - Phone:701-838-2112
Practice Address - Fax:701-838-2115
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND312103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1451948Medicaid
NDN731151OtherMEDICARE
S27601Medicare UPIN