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General NPI Number Information
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NPI Number | 1366653214
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Entity Type | Individual
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Provider Name | MARTHA JEAN EIDMANN-HICKS LMFT MDIV
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 33 N MAIN ST WYCKOFF BUILDING
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City | MARLBORO
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State | NJ
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Zip | 07746-1470
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Country | US
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Telephone | 732-834-9882
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Fax |
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Provider Business Mailing Address
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Address Line | 32 REVOLUTIONARY RD
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City | COLTS NECK
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State | NJ
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Zip | 07722-1448
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Country | US
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Telephone | 732-946-2877
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Fax | 732-946-2877
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000663
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 37F100154700
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License Number State | NJ
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