Provider Demographics
NPI:1932352556
Name:AIZENMAN, MARTA BEATRIZ (PHD)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:BEATRIZ
Last Name:AIZENMAN
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 1:45 PRINCE WILLIAM CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-4005
Mailing Address - Country:US
Mailing Address - Phone:609-924-8290
Mailing Address - Fax:609-924-8290
Practice Address - Street 1:45 PRINCE WILLIAM CT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-4005
Practice Address - Country:US
Practice Address - Phone:609-924-8290
Practice Address - Fax:609-924-8290
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJS2006101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional