MEDICARE: MS. HELENA MIMI MARTIN PH.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	103T00000X	Psychologist	PSY1000903	DC

General Provider Information

NPI Number	:	1790113322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HELENA MIMI MARTIN PH.D.

Provider Business Mailing Address
First Line	:	909 R ST NW
Second Line	:	APARTMENT B
City	:	WASHINGTON
State	:	DC
Zip	:	20001-4109
Country	:	US
Telephone Number	:	202-999-3362
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 HAREWOOD RD NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-1508
Country	:	US
Telephone Number	:	202-999-3362
Fax Number	:

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

Provider Enumeration Date	:	10/16/2013
Last Update Date	:	10/16/2013

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