Active NPI
Mario Enrique Martinez, PSY.D.
- Clinical Psychologist
- Nashville, TN
National Provider Identifier
1043463847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P693
- Practice address
- 4525 Harding Rd
Nashville, TN 37205-2119 - Phone
- (615) 736-5654
- NPI assigned
- Oct 24, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | P693 | TN | Primary |
Addresses
Primary practice location
4525 Harding Rd
Nashville, TN 37205-2119
Mailing address
4525 Harding Rd.
Nashville, TN 37205
Phone (615) 736-5654
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 621390152 | Other | TN | FEDERAL TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P693 | TN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224806400000",
"number": "1043463847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4525 HARDING RD.",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "37205",
"telephone_number": "615-736-5654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4525 HARDING RD",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372052119",
"telephone_number": "615-736-5654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINEZ",
"first_name": "MARIO",
"middle_name": "ENRIQUE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-24",
"last_updated": "2008-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "P693",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL TAX ID",
"identifier": "621390152",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nashville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.