Provider Demographics
NPI:1992868020
Name:MARTIN, SUSAN A (PSYD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N CENTRAL AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2425
Mailing Address - Country:US
Mailing Address - Phone:602-406-3729
Mailing Address - Fax:602-798-9412
Practice Address - Street 1:2927 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4102
Practice Address - Country:US
Practice Address - Phone:602-406-3153
Practice Address - Fax:602-406-4122
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3847103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist