Provider Demographics
NPI:1992742043
Name:RICH, MARTHA ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ANNE
Last Name:RICH
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 1:2612 26TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-7648
Mailing Address - Country:US
Mailing Address - Phone:507-529-0252
Mailing Address - Fax:
Practice Address - Street 1:2746 SUPERIOR DR NW
Practice Address - Street 2:SUITE 370
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8343
Practice Address - Country:US
Practice Address - Phone:507-289-7768
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4613103TC0700X
NC2820103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical