Provider Demographics
NPI:1962750141
Name:MARTELL, NICOLE G (PSYD, MBA)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:G
Last Name:MARTELL
Suffix:
Gender:F
Credentials:PSYD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 UNION AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-3648
Mailing Address - Country:US
Mailing Address - Phone:732-962-3594
Mailing Address - Fax:
Practice Address - Street 1:147 UNION AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3648
Practice Address - Country:US
Practice Address - Phone:732-962-3594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4906103TC0700X
PAPS016061103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical