Basic Information
| Provider Information | |||||||||
| NPI: | 1578646055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEYMOUR | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | NPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 CENTER DRIVE 2ND FLOOR WING | ||||||||
| Address2: | RIVERHEAD MENTAL HEALTH CLINIC,COUNTY CENTER BUILDING | ||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6311852144 | ||||||||
| FaxNumber: | 6318521448 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 CENTER DRIVE 2ND FLOOR WING | ||||||||
| Address2: | RIVERHEAD MENTAL HEALTH CLINIC,COUNTY CENTER BUILDING | ||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6311852144 | ||||||||
| FaxNumber: | 6318521448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | F400622-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.