Healthcare Provider Details

I. General information

NPI: 1134723752
Provider Name (Legal Business Name): DARIAN JAMES MARTIN M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MAIN ST RM G274
WORCESTER MA
01608-1203
US

IV. Provider business mailing address

225 MAIN ST RM G274
WORCESTER MA
01608-1203
US

V. Phone/Fax

Practice location:
  • Phone: 407-342-9380
  • Fax:
Mailing address:
  • Phone: 407-342-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: