Provider Demographics
NPI:1780158642
Name:TEMPLE-MARTIN, MICHELE COULETTE
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:COULETTE
Last Name:TEMPLE-MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 CASTLETON AVENUE
Mailing Address - Street 2:2ND FL
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310
Mailing Address - Country:US
Mailing Address - Phone:718-440-4391
Mailing Address - Fax:
Practice Address - Street 1:690 CASTLETON AVENUE
Practice Address - Street 2:2ND FL
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310
Practice Address - Country:US
Practice Address - Phone:718-440-4391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor