Provider Demographics
NPI:1336868108
Name:MARTINI, ADA PONPIPOM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:PONPIPOM
Last Name:MARTINI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3011
Mailing Address - Country:US
Mailing Address - Phone:610-698-5161
Mailing Address - Fax:
Practice Address - Street 1:122 E FIFTH ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3011
Practice Address - Country:US
Practice Address - Phone:610-698-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-008875L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical