Provider Type Icon

MARY KATHLEEN MARTIN NURSE PRACTITIONER IN PSYCHIATRY PLLC NPI 1578921623


NPI Information

NPI: 1578921623
Provider Name: MARY KATHLEEN MARTIN NURSE PRACTITIONER IN PSYCHIATRY, PLLC
Classification: Psychologist - 103TP0016X
Entity Type: Organization

Specialization: Prescribing (Medical)

Address:
21 W 2ND ST
SUITE 11
RIVERHEAD, NY
ZIP 11901
Phone: (631) 624-7839
Get Directions

MARY KATHLEEN MARTIN NURSE PRACTITIONER IN PSYCHIATRY, PLLC is a prescribing (medical) psychologist in Riverhead, NY. The provider is a licensed, doctoral-level psychologist authorized to prescribe and has undergone specialized education and training in preparation for prescriptive practice and has passed an examination accepted by the state board of psychology relevant to establishing competence for prescribing, and has received from the state board of psychology a current certificate granting prescriptive authority, which has not been revoked or suspended. MARY KATHLEEN MARTIN NURSE PRACTITIONER IN PSYCHIATRY, PLLC NPI is 1578921623. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

21 W 2ND ST
SUITE 11
RIVERHEAD, NY
ZIP 11901-752
Phone: (631) 624-7839
Fax: (631) 865-5857

The provider's authorized official is Mary Martin .
The authorized official title is Owner and has the following contact phone number (631) 766-3210.

The enumeration date for this NPI number is 2/4/2016 and was last updated on 2/4/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103TP0016XPsychologistPrescribing (Medical)401909NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
113554525OTHERNEW YORKCAQH
2363LA2200XMEDICARE PINNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.