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General NPI Number Information
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NPI Number | 1659431377
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Entity Type | Organization
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Legal Business Name | ROBERT G. MARTIN
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/15/2008
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Provider Practice Location Address
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Address Line | 8150 A COURT AVE.
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City | HAMLIN
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State | WV
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Zip | 25523-1434
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Country | US
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Telephone | 304-824-7776
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Fax | 304-824-7776
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Provider Business Mailing Address
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Address Line | 8150 A COURT AVE.
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City | HAMLIN
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State | WV
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Zip | 25523-1434
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Country | US
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Telephone | 304-824-7776
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Fax | 304-824-7776
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT G. MARTIN
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Credential | M.A.
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Telephone | 304-824-7776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 366
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License Number State | WV
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