Provider Demographics
NPI:1255626420
Name:NELSON D MARTINS PHD LLC
Entity type:Organization
Organization Name:NELSON D MARTINS PHD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PSCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:401-441-3820
Mailing Address - Street 1:800 OAKLAWN AVE
Mailing Address - Street 2:SUITE C204
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-2822
Mailing Address - Country:US
Mailing Address - Phone:401-942-3300
Mailing Address - Fax:401-943-5492
Practice Address - Street 1:800 OAKLAWN AVE
Practice Address - Street 2:SUITE C204
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-2822
Practice Address - Country:US
Practice Address - Phone:401-942-3300
Practice Address - Fax:401-943-5492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS000337103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1063580355Medicare UPIN