Healthcare Provider Details

I. General information

NPI: 1568451227
Provider Name (Legal Business Name): VIRGINIA CAROLYN MARTIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BINGHAM ST FRANKLIN BUILDING, 1ST FLOOR
PITTSBURGH PA
15203-1101
US

IV. Provider business mailing address

1011 BINGHAM ST FRANKLIN BUILDING, 1ST FLOOR
PITTSBURGH PA
15203-1101
US

V. Phone/Fax

Practice location:
  • Phone: 412-235-5445
  • Fax: 412-235-5446
Mailing address:
  • Phone: 412-235-5445
  • Fax: 412-235-5446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS016482
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: