Healthcare Provider Details

I. General information

NPI: 1225145329
Provider Name (Legal Business Name): MARTHA MONAHAN ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 WASHINGTON ST SUITE 316
SALEM MA
01970-3518
US

IV. Provider business mailing address

70 WASHINGTON ST SUITE 316
SALEM MA
01970-3518
US

V. Phone/Fax

Practice location:
  • Phone: 978-745-5144
  • Fax: 978-741-8982
Mailing address:
  • Phone: 978-745-5144
  • Fax: 978-741-8982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6800
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: