MEDICARE: DR. RUBEN GABRIEL MARTINEZ PHD

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	103TC2200X	Clinical Child & Adolescent Psychologist	PS02337	RI
2	103T00000X	Psychologist	PS02337	RI

General Provider Information

NPI Number	:	1184411670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBEN GABRIEL MARTINEZ PHD

Provider Business Mailing Address
First Line	:	85 ELIOT AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-3956
Country	:	US
Telephone Number	:	804-564-3898
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 ELIOT AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-3956
Country	:	US
Telephone Number	:	804-564-3898
Fax Number	:

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

Provider Enumeration Date	:	04/21/2025
Last Update Date	:	04/21/2025

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