Healthcare Provider Details

I. General information

NPI: 1043136013
Provider Name (Legal Business Name): ELIZABETH MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 CORNET STETSON RD
HANOVER MA
02339-2662
US

IV. Provider business mailing address

30 YARMOUTH AVE
BROCKTON MA
02301-4846
US

V. Phone/Fax

Practice location:
  • Phone: 781-856-4509
  • Fax:
Mailing address:
  • Phone: 781-856-4509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90833
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: