Provider Demographics
NPI:1255565479
Name:OLIVEIRA, MARTIN DAVID (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:DAVID
Last Name:OLIVEIRA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2719
Mailing Address - Country:US
Mailing Address - Phone:860-778-7095
Mailing Address - Fax:860-955-3036
Practice Address - Street 1:10 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1968
Practice Address - Country:US
Practice Address - Phone:860-778-7095
Practice Address - Fax:860-955-3036
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002930103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical