MEDICARE: MRS. VIRGINIA CAROLYN MARTIN 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	103TC2200X	Clinical Child & Adolescent Psychologist	PS016482	PA

General Provider Information

NPI Number	:	1568451227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIRGINIA CAROLYN MARTIN PSY.D.

Provider Business Mailing Address
First Line	:	1011 BINGHAM ST
Second Line	:	FRANKLIN BUILDING, 1ST FLOOR
City	:	PITTSBURGH
State	:	PA
Zip	:	15203-1101
Country	:	US
Telephone Number	:	412-235-5445
Fax Number	:	412-235-5446

Provider Business Practice Location Address
First Line	:	1011 BINGHAM ST
Second Line	:	FRANKLIN BUILDING, 1ST FLOOR
City	:	PITTSBURGH
State	:	PA
Zip	:	15203-1101
Country	:	US
Telephone Number	:	412-235-5445
Fax Number	:	412-235-5446

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	09/17/2008

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