MEDICARE: DR. DENISE M. MARTZ PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2381	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0406L	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053367888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENISE M. MARTZ PH.D.

Provider Business Mailing Address
First Line	:	102 MEADOW LARK WAY
Second Line	:	HOMESTEAD
City	:	VILAS
State	:	NC
Zip	:	28692-8801
Country	:	US
Telephone Number	:	828-297-4605
Fax Number	:

Provider Business Practice Location Address
First Line	:	DEPARTMENT OF PSYCHOLOGY
Second Line	:	APPALACHIAN STATE UNIVERSITY- SMITH WRIGHT HALL
City	:	BOONE
State	:	NC
Zip	:	28608-0001
Country	:	US
Telephone Number	:	828-262-2715
Fax Number	:	828-262-2974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/08/2007

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