Provider Demographics
NPI:1477615276
Name:DEMARTINI, WILLIAM D (EDD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:DEMARTINI
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 E TRADEWINDS AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5010
Mailing Address - Country:US
Mailing Address - Phone:954-772-6707
Mailing Address - Fax:
Practice Address - Street 1:4324 E TRADEWINDS AVE
Practice Address - Street 2:
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-5010
Practice Address - Country:US
Practice Address - Phone:954-772-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003060103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75432Medicare ID - Type Unspecified