Provider Demographics
NPI:1548468531
Name:MARTIN, ELAINE STUART (PHD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:STUART
Last Name:MARTIN
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 1:5 E 22ND ST APT 30M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5319
Mailing Address - Country:US
Mailing Address - Phone:212-254-0854
Mailing Address - Fax:
Practice Address - Street 1:5 E 22ND ST APT 30M
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5319
Practice Address - Country:US
Practice Address - Phone:212-254-0854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9197103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist