Provider Demographics
NPI:1669532123
Name:MARTIN, ALBERT A (PHD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:A
Last Name:MARTIN
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 1:150 PARKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-2209
Mailing Address - Country:US
Mailing Address - Phone:219-696-7280
Mailing Address - Fax:
Practice Address - Street 1:416 E 86TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6211
Practice Address - Country:US
Practice Address - Phone:219-769-3868
Practice Address - Fax:219-696-8569
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010344A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical