Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2122 | MA |
N | 103T00000X | Psychologist | 2122 | MA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 2122 | MA |
NPI | 1184681595 |
---|---|
Provider Name | Dr. Thomas Phillip Martin |
First Address | Hamilton, MA 01982-1504 |
Second Address | Tewksbury, MA 01876-1950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 08/07/2007 |