Provider Demographics
NPI:1922455567
Name:MARTIN, REBECCA (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 MAXWELL DR STE 205
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2933
Mailing Address - Country:US
Mailing Address - Phone:518-288-7156
Mailing Address - Fax:518-309-7838
Practice Address - Street 1:10 MAXWELL DR STE 205
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2933
Practice Address - Country:US
Practice Address - Phone:518-288-7156
Practice Address - Fax:518-309-7838
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021583103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist