Provider Demographics
NPI:1922148915
Name:MARTIN, MARGUERITE
Entity Type:Individual
Prefix:DR
First Name:MARGUERITE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3525
Mailing Address - Country:US
Mailing Address - Phone:646-285-4322
Mailing Address - Fax:845-386-6710
Practice Address - Street 1:208 WICKHAM AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3801
Practice Address - Country:US
Practice Address - Phone:646-285-4322
Practice Address - Fax:845-386-6710
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0131551103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY490310OtherVALUE OPTIONS
NY02043016Medicaid
NM13551OtherGHI
CTP2881306OtherOXFORD
NY400180OtherMVP