Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PS007004L | PA |
N | 103T00000X | Psychologist | PS007004L | PA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 5824 | PA |
NPI | 1588718928 |
---|---|
Provider Name | Holly Jean Martin |
First Address | Canonsburg, PA 15317-4838 |
Second Address | Washington, PA 15301-2967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |