| Doctor Name: | MR. BENNY RAY MARTIN |
| NPI Number: | 1124150180 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | PY00003320 |
| Business Practice Address: | 10333 El Camino Real Atascadero, CA - 934225808 |
| Business Phone Number: | 8054682000 |
| Business Fax Number: | 8054686011 |
| Mailing Address: | 1600 9th Street, Room 150, Fiscal Allocations And Estimates Unit SACRAMENTO |
| State: | CA |
| Postal Code: | 958146414 |
| Phone Number: | 9166519475 |
| Fax Number: | 9166518908 |
| NPI Enumeration Date: | 03/12/2007 |
| NPI Last Update Date: | 07/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY00003320 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |