Provider Demographics
NPI:1699883702
Name:FIEDLER, MARTHA L (PHD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:FIEDLER
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 1:121 WELLESLEY DRIVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1443
Mailing Address - Country:US
Mailing Address - Phone:505-266-0025
Mailing Address - Fax:505-266-0023
Practice Address - Street 1:121 WELLESLEY DRIVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1443
Practice Address - Country:US
Practice Address - Phone:505-266-0025
Practice Address - Fax:505-266-0023
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM164103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical