Healthcare Provider Details

I. General information

NPI: 1114866894
Provider Name (Legal Business Name): MADISON MARTINS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 ATLANTIC AVE
LONG BEACH CA
90807-2229
US

IV. Provider business mailing address

4470 ATLANTIC AVE PO BOX 17245
LONG BEACH CA
90807-2229
US

V. Phone/Fax

Practice location:
  • Phone: 480-593-1133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY33365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: