Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 3753 | MA |
N | 103T00000X | Psychologist | 3753 | MA |
N | 102L00000X | Psychologist | PS00337 | RI |
N | 103T00000X | Psychologist | PS00337 | RI |
N | 103G00000X | Clinical Psychologist | 3753 | MA |
N | 103TC0700X | Clinical Psychologist | 3753 | MA |
Y | 103G00000X | Clinical Psychologist | PS00337 | RI |
Y | 103TC0700X | Clinical Psychologist | PS00337 | RI |
N | 103TS0200X | School Psychologist | 3753 | MA |
N | 103TS0200X | School Psychologist | PS00337 | RI |
NPI | 1063580355 |
---|---|
Provider Name | Dr. Nelson Dias Martins |
First Address | Greenville, RI 02828-1753 |
Second Address | Cranston, RI 02920-2822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2006 |
Last Update Date | 09/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03332-5 | BLUE CROSS OF RI (01) | RI |
412300 | BLUE CHIP OF RI (01) | RI |