Healthcare Provider Details

I. General information

NPI: 1568451227
Provider Name (Legal Business Name): VIRGINIA CAROLYN MARTIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 TAMIAMI TRL S STE 283
VENICE FL
34285-2441
US

IV. Provider business mailing address

333 TAMIAMI TRL S STE 283
VENICE FL
34285-2441
US

V. Phone/Fax

Practice location:
  • Phone: 412-979-0262
  • Fax:
Mailing address:
  • Phone: 412-979-0262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY11071
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS016482
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: