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General NPI Number Information
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NPI Number | 1780635805
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Entity Type | Individual
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Provider Name | NICHOLAS V MARTINO JR. PSYD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 344 N READING RD
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City | EPHRATA
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State | PA
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Zip | 17522-1651
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Country | US
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Telephone | 717-738-1125
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Fax |
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Provider Business Mailing Address
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Address Line | 601 MEMORY LN
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City | YORK
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State | PA
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Zip | 17402-2231
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Country | US
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Telephone | 717-851-1405
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Fax | 717-851-6969
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS006579L
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License Number State | PA
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