Provider Demographics
NPI:1922384171
Name:PHILIPPI, MARTA I (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:I
Last Name:PHILIPPI
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 1:355 CALLE 16
Mailing Address - Street 2:URB. VILLA NEVAREZ
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-5112
Mailing Address - Country:US
Mailing Address - Phone:787-725-6500
Mailing Address - Fax:
Practice Address - Street 1:355 CALLE 16
Practice Address - Street 2:URB. VILLA NEVAREZ
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5112
Practice Address - Country:US
Practice Address - Phone:787-725-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001897103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR001897OtherDEPARTMENT OF HEALTH