Provider Demographics
NPI:1992234546
Name:WHITTINGHAM, MARTYN SIMON (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTYN
Middle Name:SIMON
Last Name:WHITTINGHAM
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 1:8032 QUAIL MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1990
Mailing Address - Country:US
Mailing Address - Phone:513-827-1430
Mailing Address - Fax:
Practice Address - Street 1:3001 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2315
Practice Address - Country:US
Practice Address - Phone:513-961-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6486103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty