Provider Demographics
NPI:1780749747
Name:MARTIN, DANA LYN (MA)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:LYN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475
Mailing Address - Country:US
Mailing Address - Phone:860-235-9431
Mailing Address - Fax:
Practice Address - Street 1:190 WESTBROOK ROAD
Practice Address - Street 2:ESSEX CHILD GUIDANCE CLINIC
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426
Practice Address - Country:US
Practice Address - Phone:860-767-0147
Practice Address - Fax:860-767-0148
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health