Provider Demographics
NPI:1457415168
Name:MARTIN, LYNDA M (MS F AAA)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS F AAA
Other - Prefix:MS
Other - First Name:LYNDA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS-FAAA
Mailing Address - Street 1:490 SHREWSBURY ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1607
Mailing Address - Country:US
Mailing Address - Phone:508-755-1391
Mailing Address - Fax:508-363-4019
Practice Address - Street 1:295 LINCOLN ST
Practice Address - Street 2:STE 105
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-755-1391
Practice Address - Fax:508-363-4019
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA135231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
043258935OtherUNICARE
680034OtherSECURE HORIZONS
680034OtherTUFTS
AS8957304000OtherCIGNA OUT OF NETWORK
MA5102669Medicaid
043258935OtherGIC GROUP INS COMMISSION
043258935OtherUNITED HEALTH CARE
043258935OtherAETNA
26550OtherFALLON
650422OtherHARVARD PILGRIM
WORC22004OtherHEAR PO
043258935OtherUNICARE