=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689736621
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTIN JOHN AMERIKANER PH. D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 845 4TH AVE
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25701-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-523-8911
-----------------------------------------------------
Fax | 304-523-8912
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 10TH AVE W
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25701-3106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-522-1921
-----------------------------------------------------
Fax | 304-696-2784
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 449
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------