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General NPI Number Information
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NPI Number | 1861254641
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Entity Type | Individual
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Provider Name | KATHERINE THELMA MARTIN M.ED.
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Gender | Female
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 722 S 10TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-1916
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Country | US
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Telephone | 215-990-7937
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Fax |
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Provider Business Mailing Address
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Address Line | 722 S 10TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-1916
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Country | US
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Telephone | 215-990-7937
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS006214L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PS006214L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS006214L
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | PS006214L
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS006214L
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License Number State | PA
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