Provider Demographics
NPI:1407680168
Name:MARTELLUCCI, KATAMA
Entity type:Individual
Prefix:
First Name:KATAMA
Middle Name:
Last Name:MARTELLUCCI
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3012
Mailing Address - Country:US
Mailing Address - Phone:610-653-5307
Mailing Address - Fax:
Practice Address - Street 1:419 SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3012
Practice Address - Country:US
Practice Address - Phone:610-653-5307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor