Provider Demographics
NPI:1265421747
Name:MARTINO, DAVID GUY (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GUY
Last Name:MARTINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E WASHINGTON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-3909
Mailing Address - Country:US
Mailing Address - Phone:319-354-3232
Mailing Address - Fax:319-354-2990
Practice Address - Street 1:209 E WASHINGTON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-3909
Practice Address - Country:US
Practice Address - Phone:319-354-3232
Practice Address - Fax:319-354-2990
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00754103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA29335OtherWELLMARK BXBS
IA29335OtherWELLMARK BXBS