Provider Demographics
NPI:1871534800
Name:MARTIN, ELAINE A (MA ATRBC LPC)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA ATRBC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:OTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18942
Mailing Address - Country:US
Mailing Address - Phone:610-847-8183
Mailing Address - Fax:
Practice Address - Street 1:727 WELSH RD
Practice Address - Street 2:STE 202
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006
Practice Address - Country:US
Practice Address - Phone:215-514-2119
Practice Address - Fax:914-211-9166
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health