Provider Demographics
NPI:1700974540
Name:MARTORANO, RAYMOND D (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:D
Last Name:MARTORANO
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 1:8007 LYNDON CENTRE WAY
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222
Mailing Address - Country:US
Mailing Address - Phone:502-690-8024
Mailing Address - Fax:
Practice Address - Street 1:8007 LYNDON CENTRE WAY STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3608
Practice Address - Country:US
Practice Address - Phone:502-690-8024
Practice Address - Fax:502-690-8090
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY167029103TA0400X
KY129056103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124019047OtherWRIGHT PATTERSON MEDICAL CENTER