Healthcare Provider Details

I. General information

NPI: 1932605565
Provider Name (Legal Business Name): EDWINA LATASHA MARTIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EDWINA LATASHA REECE PH.D.

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO AE
09180
US

IV. Provider business mailing address

PSC 402 BOX 106
APO AE
09180-0002
US

V. Phone/Fax

Practice location:
  • Phone: 315-634-3272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35204
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: