Provider Demographics
NPI:1215077227
Name:MARTYNENKO, MARIYA I (MA)
Entity type:Individual
Prefix:MRS
First Name:MARIYA
Middle Name:I
Last Name:MARTYNENKO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 RIVER RD APT L
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3639
Mailing Address - Country:US
Mailing Address - Phone:973-661-5234
Mailing Address - Fax:
Practice Address - Street 1:452 RIVER RD.
Practice Address - Street 2:APT.L
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110
Practice Address - Country:US
Practice Address - Phone:973-661-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00315800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional