| Charles R. Martin, Ph.d., Llc | |
|
2631 Nw 41st St E-6 Gainesville FL 32606-7470 | |
| (352) 375-7756 | |
| Not Available |
| Full Name | Charles R. Martin, Ph.d., Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2631 Nw 41st St, Gainesville, Florida |
| Authorized Official Name and Position | Charles R Martin (PRESIDENT) |
| Authorized Official Contact | 3523757756 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles R. Martin, Ph.d., Llc 2631 Nw 41st St E-6 Gainesville FL 32606-7470 Ph: (352) 375-7756 | Charles R. Martin, Ph.d., Llc 2631 Nw 41st St E-6 Gainesville FL 32606-7470 Ph: (352) 375-7756 |
| NPI Number | 1386189314 |
|---|---|
| Provider Enumeration Date | 12/29/2016 |
| Last Update Date | 12/29/2016 |
| Medicare PECOS PAC ID | 6507129228 |
|---|---|
| Medicare Enrollment ID | O20180411001625 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386189314 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | PY5214 (Florida) | Primary |
| Provider Name | Charles Rochelle Martin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407071731 PECOS PAC ID: 7416210141 Enrollment ID: I20180411001733 |
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