Provider Demographics
NPI:1447309133
Name:MEYER, MARTIN BARRY (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:BARRY
Last Name:MEYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 FORRESTER RD
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-2515
Mailing Address - Country:US
Mailing Address - Phone:724-794-1954
Mailing Address - Fax:724-794-1905
Practice Address - Street 1:220 S MAIN ST
Practice Address - Street 2:SUITE 304
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5987
Practice Address - Country:US
Practice Address - Phone:724-287-5604
Practice Address - Fax:724-287-3779
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006079L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA156500OtherVALUE OPTIONS PROVDER #
PA702165OtherHIGHMARK PROVIDER ID