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NPI Code Detail

MEDICARE: BROOKE MARTON PSYD

MEDICARE: BROOKE MARTON PSYD
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
1103T00000XPsychologistPS020713PA

General Provider Information

NPI Number : 1720709132
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE MARTON PSYD
Provider Business Mailing Address
First Line : 255 S 17TH ST STE 1010
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19103-6210
Country : US
Telephone Number : 267-507-1310
Fax Number :
Provider Business Practice Location Address
First Line : 255 S 17TH ST STE 1010
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19103-6210
Country : US
Telephone Number : 267-507-1310
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2022
Last Update Date : 04/02/2026

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Directions to “ BROOKE MARTON PSYD” Practice Location

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