Provider Demographics
NPI:1790113322
Name:MARTIN, HELENA MIMI (PHD)
Entity Type:Individual
Prefix:MS
First Name:HELENA
Middle Name:MIMI
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 1:909 R ST NW
Mailing Address - Street 2:APARTMENT B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4109
Mailing Address - Country:US
Mailing Address - Phone:202-999-3362
Mailing Address - Fax:
Practice Address - Street 1:4001 HAREWOOD RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-1508
Practice Address - Country:US
Practice Address - Phone:202-999-3362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000903103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist