Provider Demographics
NPI:1588751804
Name:MARTONE, FREDERICK MICHAEL (PHD)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:MICHAEL
Last Name:MARTONE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2253 E DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-4126
Mailing Address - Country:US
Mailing Address - Phone:626-437-8172
Mailing Address - Fax:866-844-3542
Practice Address - Street 1:2253 E DUDLEY ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-4126
Practice Address - Country:US
Practice Address - Phone:626-437-8172
Practice Address - Fax:616-791-5332
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9293103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist