Provider Demographics
NPI:1699047860
Name:MARTIN, CHERIE N (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHERIE
Middle Name:N
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 ELMER ST
Mailing Address - Street 2:WILLIAM BREZINSKI, MA, LLC
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740
Mailing Address - Country:US
Mailing Address - Phone:304-487-6121
Mailing Address - Fax:304-487-8741
Practice Address - Street 1:199 ELMER ST
Practice Address - Street 2:WILLIAM BREZINSKI, MA, LLC
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740
Practice Address - Country:US
Practice Address - Phone:304-487-6121
Practice Address - Fax:304-487-8741
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1034103TC0700X
GAPSY003401103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical