Healthcare Provider Details

I. General information

NPI: 1265255079
Provider Name (Legal Business Name): GABRIELLA MARTIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 LEXINGTON GREEN CIR STE 420
LEXINGTON KY
40503-3337
US

IV. Provider business mailing address

230 LEXINGTON GREEN CIR STE 420
LEXINGTON KY
40503-3337
US

V. Phone/Fax

Practice location:
  • Phone: 859-287-0760
  • Fax:
Mailing address:
  • Phone: 859-287-0760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number294818
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: