| Doctor Name: | DR. PATRICIA PETERS MARTIN |
| NPI Number: | 1316048549 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH. D. |
| License Number: | 3971 |
| Business Practice Address: | 1200 Converse St Suite 202 Longmeadow, MA - 011061760 |
| Business Phone Number: | 4135670380 |
| Business Fax Number: | 4135670380 |
| Mailing Address: | 38 Oxford Rd, LONGMEADOW |
| State: | MA |
| Postal Code: | 011061530 |
| Phone Number: | 4135670380 |
| Fax Number: | 4135670380 |
| NPI Enumeration Date: | 09/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 3971 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |