1366653214 NPI number — MRS. MARTHA JEAN EIDMANN-HICKS LMFT MDIV

Table of content: MRS. MARTHA JEAN EIDMANN-HICKS LMFT MDIV (NPI 1366653214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366653214 NPI number — MRS. MARTHA JEAN EIDMANN-HICKS LMFT MDIV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EIDMANN-HICKS
Provider First Name:
MARTHA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT MDIV
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HICKS
Provider Other First Name:
MARTHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT MDIV
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1366653214
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 REVOLUTIONARY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLTS NECK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07722-1448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-946-2877
Provider Business Mailing Address Fax Number:
732-946-2877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 N MAIN ST
Provider Second Line Business Practice Location Address:
WYCKOFF BUILDING
Provider Business Practice Location Address City Name:
MARLBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07746-1470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-834-9882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  000663 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 37F100154700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)