Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PA |
NPI | 1063087484 |
---|---|
Provider Name | Josue Martinez |
First Address | Bensalem, PA 19020-2217 |
Second Address | Bensalem, PA 19020-2217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2021 |
Last Update Date | 26/05/2021 |