MEDICARE: DR. MARTHA MERCHANT PSY.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	26986	CA
2	103TC2200X	Clinical Child & Adolescent Psychologist	26986	CA
3	106H00000X	Marriage & Family Therapist	1651	MN
4	103T00000X	Psychologist	26986	CA

General Provider Information

NPI Number	:	1508087552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA MERCHANT PSY.D.

Provider Business Mailing Address
First Line	:	50 BALMY ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-4111
Country	:	US
Telephone Number	:	415-547-0838
Fax Number	:	415-680-1703

Provider Business Practice Location Address
First Line	:	50 BALMY ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-4111
Country	:	US
Telephone Number	:	415-547-0838
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	02/09/2023

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