Provider Demographics
NPI:1548692023
Name:MARTIN, LYNDA
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:
Other - Last Name:ROZZI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:450 STANYAN ST.
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1019
Mailing Address - Country:US
Mailing Address - Phone:650-867-0954
Mailing Address - Fax:
Practice Address - Street 1:254 W 54TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5516
Practice Address - Country:US
Practice Address - Phone:973-475-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83400106H00000X
NY001387106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist