Healthcare Provider Details

I. General information

NPI: 1245244714
Provider Name (Legal Business Name): LINDA E MARTIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 BREVARD AVE STE 100
COCA FL
32922
US

IV. Provider business mailing address

240 NERA AVE
MERRITT ISLAND FL
32952
US

V. Phone/Fax

Practice location:
  • Phone: 321-433-1466
  • Fax: 321-433-1467
Mailing address:
  • Phone: 321-433-1466
  • Fax: 321-433-1467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY3875
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT1001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: