Healthcare Provider Details

I. General information

NPI: 1184758211
Provider Name (Legal Business Name): MARTHA COLLETTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 NEPTUNE ST
BEVERLY MA
01915-4726
US

IV. Provider business mailing address

PO BOX 237
PRIDES CROSSING MA
01965-0237
US

V. Phone/Fax

Practice location:
  • Phone: 978-921-5080
  • Fax: 978-927-1946
Mailing address:
  • Phone: 978-922-2046
  • Fax: 978-927-1946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2347
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2347
License Number StateMA

VIII. Authorized Official

Name: TED HERON
Title or Position: MANAGER
Credential:
Phone: 978-922-2046