| Mary Kathleen Martin Nurse Practitioner In Psychiatry, Pllc | |
|
21 W 2nd St Suite 11 Riverhead NY 11901-2752 | |
| (631) 624-7839 | |
| (631) 865-5857 |
| Full Name | Mary Kathleen Martin Nurse Practitioner In Psychiatry, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 21 W 2nd St, Riverhead, New York |
| Authorized Official Name and Position | Mary Martin (OWNER) |
| Authorized Official Contact | 6317663210 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Kathleen Martin Nurse Practitioner In Psychiatry, Pllc 375 W Mill Rd Mattituck NY 11952-2079 Ph: (631) 766-3210 | Mary Kathleen Martin Nurse Practitioner In Psychiatry, Pllc 21 W 2nd St Suite 11 Riverhead NY 11901-2752 Ph: (631) 624-7839 |
| NPI Number | 1578921623 |
|---|---|
| Provider Enumeration Date | 02/04/2016 |
| Last Update Date | 02/04/2016 |
| Medicare PECOS PAC ID | 8426344375 |
|---|---|
| Medicare Enrollment ID | O20160901001987 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578921623 | NPI | - | NPPES |
| 13554525 | Other | NY | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | 401909 (New York) | Primary |
| Provider Name | Mary K Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477863082 PECOS PAC ID: 1850576034 Enrollment ID: I20110503000785 |
| Provider Name | Carol Ann Payton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114669447 PECOS PAC ID: 3476929811 Enrollment ID: I20221026001177 |
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