Provider Demographics
NPI:1700447398
Name:MARTIN, DEAN (NYS PEER SPECIALIST)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:NYS PEER SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BARKER AVE APT 6A
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1663
Mailing Address - Country:US
Mailing Address - Phone:914-356-1528
Mailing Address - Fax:
Practice Address - Street 1:35 BARKER AVE APT 6A
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1663
Practice Address - Country:US
Practice Address - Phone:914-356-1528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-P-2717175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist