Provider Demographics
NPI:1285885244
Name:MOLINE POENARU, MARTHA BRIDGETT (MA,LLP)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:BRIDGETT
Last Name:MOLINE POENARU
Suffix:
Gender:F
Credentials:MA,LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42705 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1772
Mailing Address - Country:US
Mailing Address - Phone:248-697-2664
Mailing Address - Fax:
Practice Address - Street 1:42705 GRAND RIVER AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1772
Practice Address - Country:US
Practice Address - Phone:248-697-2664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013635103T00000X
MI6361006806103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist