Provider Demographics
NPI:1184869356
Name:MARTIN, FREDERICK ARTHUR (PHD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ARTHUR
Last Name:MARTIN
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 1:1232 MILL WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4368
Mailing Address - Country:US
Mailing Address - Phone:209-598-9851
Mailing Address - Fax:
Practice Address - Street 1:1232 MILL WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4368
Practice Address - Country:US
Practice Address - Phone:209-598-9851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20746103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist