Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 35SI00499600 | NJ |
Y | 103T00000X | Psychologist | 35SI00499600 | NJ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 35SI00499600 | NJ |
N | 103TA0700X | Adult Development & Aging Psychologist | 35SI00499600 | NJ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 35SI00499600 | NJ |
N | 103G00000X | Clinical Psychologist | 35SI00499600 | NJ |
N | 103TC0700X | Clinical Psychologist | 35SI00499600 | NJ |
N | 103TC1900X | Counseling Psychologist | 35SI00499600 | NJ |
N | 103TM1800X | Intellectual & Developmental Disabilities | 35SI00499600 | NJ |
N | 103TP2701X | Group Psychotherapist | 35SI00499600 | NJ |
NPI | 1881023992 |
---|---|
Provider Name | Renata Martins |
First Address | Cresskill, NJ 07626-2141 |
Second Address | Cresskill, NJ 07626-2141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2013 |
Last Update Date | 08/11/2013 |