Healthcare Provider Details

I. General information

NPI: 1700974540
Provider Name (Legal Business Name): RAYMOND D MARTORANO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/27/2023
Certification Date: 05/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8007 LYNDON CENTRE WAY STE 101
LOUISVILLE KY
40222-3608
US

IV. Provider business mailing address

8007 LYNDON CENTRE WAY SUITE # 101
LOUISVILLE KY
40222
US

V. Phone/Fax

Practice location:
  • Phone: 502-690-8024
  • Fax: 502-690-8090
Mailing address:
  • Phone: 502-690-8024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number167029
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number129056
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: