Provider Demographics
NPI:1528165222
Name:MARKOWITZ, MARTHA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:MARKOWITZ
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 1:178 BELLEVUE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1813
Mailing Address - Country:US
Mailing Address - Phone:617-527-8124
Mailing Address - Fax:
Practice Address - Street 1:93 UNION ST
Practice Address - Street 2:SUITE 305C
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2244
Practice Address - Country:US
Practice Address - Phone:617-527-8124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4366103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04239OtherPROVIDER NUMBER FOR BCBS