Basic Information
| Provider Information | |||||||||
| NPI: | 1750955621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | AUBREY | ||||||||
| MiddleName: | JEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 159 W PARK AVE | ||||||||
| Address2: | |||||||||
| City: | PEARL RIVER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109652249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458634435 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21-23 GRAND ST | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455627244 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2021 | ||||||||
| LastUpdateDate: | 07/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.