MEDICARE: DR. YVONNE MARTINEZ THORNE ED.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS016085	PA
2	103TC1900X	Counseling Psychologist	PS016085	PA
3	103TF0000X	Family Psychologist	PS016085	PA
4	103T00000X	Psychologist	PS016085	PA
5	103TP2701X	Group Psychotherapy Psychologist	PS016085	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053498386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YVONNE MARTINEZ THORNE ED.D.

Provider Business Mailing Address
First Line	:	8627 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-2839
Country	:	US
Telephone Number	:	610-304-4782
Fax Number	:	484-231-8304

Provider Business Practice Location Address
First Line	:	34 E GERMANTOWN PIKE # 183
Second Line	:
City	:	EAST NORRITON
State	:	PA
Zip	:	19401-1512
Country	:	US
Telephone Number	:	610-304-4782
Fax Number	:	484-231-8304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	02/14/2012

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Directions to “ DR. YVONNE MARTINEZ THORNE ED.D.” Practice Location

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