Provider Demographics
NPI:1922879535
Name:HARRELL, MARTHA (MSN, PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:MSN, PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W 72ND ST APT 12B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3341
Mailing Address - Country:US
Mailing Address - Phone:917-842-6999
Mailing Address - Fax:
Practice Address - Street 1:124 W 72ND ST APT 12B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3341
Practice Address - Country:US
Practice Address - Phone:917-842-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000233102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst