Provider Demographics
NPI:1124237029
Name:MARTIN, JUANITA K (PHD)
Entity type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:K
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 SIMMONS HALL
Mailing Address - Street 2:UNIVERSITY OF AKRON
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44325-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:306 SIMMONS HALL
Practice Address - Street 2:UNIVERSITY OF AKRON
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44325-4303
Practice Address - Country:US
Practice Address - Phone:330-972-7082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical