Provider Demographics
NPI:1922290261
Name:FLEISCHMAN, MARTY (PHD, MAC)
Entity Type:Individual
Prefix:DR
First Name:MARTY
Middle Name:
Last Name:FLEISCHMAN
Suffix:
Gender:M
Credentials:PHD, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1272
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-2303
Mailing Address - Country:US
Mailing Address - Phone:831-703-4202
Mailing Address - Fax:
Practice Address - Street 1:806 QUIGG WAY
Practice Address - Street 2:
Practice Address - City:BOULDER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95006-9062
Practice Address - Country:US
Practice Address - Phone:831-703-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)