Provider Demographics
NPI:1336159326
Name:KEMP, MARTHA ALLISON (PH D)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ALLISON
Last Name:KEMP
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18528 NW 23RD PL
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2152
Mailing Address - Country:US
Mailing Address - Phone:352-472-2974
Mailing Address - Fax:
Practice Address - Street 1:225 SW 7TH TERRACE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601
Practice Address - Country:US
Practice Address - Phone:352-379-2829
Practice Address - Fax:352-379-2843
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6664103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73055Medicare ID - Type Unspecified