Provider Demographics
NPI:1043533912
Name:MARTIN, KEONNA JANEEN (MS)
Entity type:Individual
Prefix:
First Name:KEONNA
Middle Name:JANEEN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2927 N 5TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-2800
Mailing Address - Country:US
Mailing Address - Phone:215-634-6400
Mailing Address - Fax:215-634-8978
Practice Address - Street 1:2927 N 5TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-2800
Practice Address - Country:US
Practice Address - Phone:215-634-6400
Practice Address - Fax:215-634-8978
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor