Provider Demographics
NPI:1790200806
Name:MARTINI, JAY (PHD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:MARTINI
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 1:1520 CHERRYLANE PL S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-3529
Mailing Address - Country:US
Mailing Address - Phone:206-745-2121
Mailing Address - Fax:
Practice Address - Street 1:1800 112TH AVE NE STE 260E
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2937
Practice Address - Country:US
Practice Address - Phone:425-977-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA60804346103K00000X
WAPY60805415103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst