MEDICARE: LYNDA MARTIN

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	106H00000X	Marriage & Family Therapist	83400	CA
2	106H00000X	Marriage & Family Therapist	001387	NY

General Provider Information

NPI Number	:	1548692023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDA MARTIN

Provider Business Mailing Address
First Line	:	450 STANYAN ST.
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-1019
Country	:	US
Telephone Number	:	650-867-0954
Fax Number	:

Provider Business Practice Location Address
First Line	:	254 W 54TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-5516
Country	:	US
Telephone Number	:	973-475-5131
Fax Number	:

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

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	07/21/2022

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Directions to “ LYNDA MARTIN ” Practice Location

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