Active NPI
Suzanne Gabrielle Martin, PSYD
- Clinical Psychologist
- Camp Lejeune, NC
National Provider Identifier
1417983511
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3267
- Practice address
- 100 Brewster Blvd
Naval Hospital
Camp Lejeune, NC 28547-2538 - Phone
- (910) 450-4159
- Fax
- (910) 450-4194
- NPI assigned
- Jun 23, 2006
- Last updated
- Mar 8, 2012
- Sex
- Female
- 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 | 3267 | NC | Primary |
Addresses
Primary practice location
100 Brewster Blvd
Naval Hospital
Camp Lejeune, NC 28547-2538
Mailing address
100 Brewster Blvd
Naval Hospital
Camp Lejeune, NC 28547-2538
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0018539600001 | Medicaid | PA |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3267 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331164800000",
"number": "1417983511",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 BREWSTER BLVD",
"address_2": "NAVAL HOSPITAL",
"city": "CAMP LEJEUNE",
"state": "NC",
"postal_code": "285472538"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 BREWSTER BLVD",
"address_2": "NAVAL HOSPITAL",
"city": "CAMP LEJEUNE",
"state": "NC",
"postal_code": "285472538",
"telephone_number": "910-450-4159",
"fax_number": "910-450-4194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "SUZANNE",
"middle_name": "GABRIELLE",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-23",
"last_updated": "2012-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "3267",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0018539600001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Camp Lejeune, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.