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General NPI Number Information
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NPI Number | 1972070530
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Entity Type | Organization
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Legal Business Name | INTEGRAL MENTAL MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 10/31/2018
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 226 MILL ST
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City | BRISTOL
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State | PA
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Zip | 19007-4809
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Country | US
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Telephone | 610-601-3877
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Fax |
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Provider Business Mailing Address
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Address Line | 45 E CITY AVE # 1578
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City | BALA CYNWYD
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State | PA
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Zip | 19004-2421
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Country | US
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Telephone | 610-601-3877
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Fax | 610-273-5685
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JONATHAN MARTINEZ
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Credential | MD
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Telephone | 347-988-8598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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