Provider Demographics
NPI:1962698407
Name:PIERRE, MARTIN RANDY (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:RANDY
Last Name:PIERRE
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 1:19 ROWENA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-4911
Mailing Address - Country:US
Mailing Address - Phone:617-224-7289
Mailing Address - Fax:617-524-4169
Practice Address - Street 1:172 ASHMONT ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-3745
Practice Address - Country:US
Practice Address - Phone:617-224-7289
Practice Address - Fax:617-524-4169
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8761103TC1900X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service