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General NPI Number Information
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NPI Number | 1851060628
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Entity Type | Individual
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Provider Name | MARTHA FISKEAUX
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Gender | Female
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 06/25/2024
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Provider Practice Location Address
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Address Line | 10000 BAY PINES BLVD
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City | BAY PINES
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State | FL
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Zip | 33744-8200
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Country | US
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Telephone | 727-398-6661
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Fax |
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Provider Business Mailing Address
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Address Line | 3435 N DRUID HILLS RD APT L
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City | DECATUR
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State | GA
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Zip | 30033-3758
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Country | US
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Telephone | 813-838-2226
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY004788
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License Number State | GA
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