Individual provider Active NPI

Katherine Thelma Martin, M.ED.

  • Clinical Psychologist
  • Philadelphia, PA
National Provider Identifier
1861254641
Registry record updated Jan 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS006214L Issued in PA
Practice address
722 S 10TH St
Philadelphia, PA 19147-1916
Phone
(215) 990-7937
NPI assigned
Jan 26, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PS006214L PA
Cognitive & Behavioral Psychologist 103TB0200X PS006214L PA
Clinical Child & Adolescent Psychologist 103TC2200X PS006214L PA
Family Psychologist 103TF0000X PS006214L PA
Clinical Psychologist 103TC0700X PS006214L PA Primary

Addresses

Primary practice location

722 S 10TH St
Philadelphia, PA 19147-1916

Mailing address

722 S 10TH St
Philadelphia, PA 19147-1916
Phone (215) 990-7937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250912000172 PA Practitioner - Psychologist Billing Independently 7911423124 Practice locations: Philadelphia, PA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Temple University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1 University Plaza Dr
Hackensack, NJ 07601-6229

722 S 10TH St
Philadelphia, PA 19147-1916
Phone (215) 990-7937

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Education

State licenses

LicenseStateTypeSpecialty
PS006214LPAMDFamily Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1861254641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "722 S 10TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191471916",
            "telephone_number": "215-990-7937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 S 10TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191471916",
            "telephone_number": "215-990-7937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "KATHERINE",
        "middle_name": "THELMA",
        "credential": "M.ED.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-26",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS006214L",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "PA",
            "license": "PS006214L",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "PA",
            "license": "PS006214L",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "PA",
            "license": "PS006214L",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS006214L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.