Active NPI
George Mario Martinez, CERTIFED PSYCHOLOGIC
- Cognitive & Behavioral Psychologist
- Somerset, KY
National Provider Identifier
1912182064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- License
- 0186
- Practice address
- 401 Bogle St
Suite 102
Somerset, KY 42503-3823 - Phone
- (606) 676-0638
- Fax
- (606) 679-1889
- NPI assigned
- Jan 8, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 0186 | KY | Primary |
Addresses
Primary practice location
401 Bogle St
Suite 102
Somerset, KY 42503-3823
Mailing address
401 Bogle St
Suite 102
Somerset, KY 42503-3823
Phone (606) 676-0638
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 |
|---|---|---|---|
| 0186 | KY | MD | Cognitive & Behavioral Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199750400000",
"number": "1912182064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 BOGLE ST",
"address_2": "SUITE 102",
"city": "SOMERSET",
"state": "KY",
"postal_code": "425033823",
"telephone_number": "606-676-0638",
"fax_number": "606-679-1889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 BOGLE ST",
"address_2": "SUITE 102",
"city": "SOMERSET",
"state": "KY",
"postal_code": "425033823",
"telephone_number": "606-676-0638",
"fax_number": "606-679-1889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINEZ",
"first_name": "GEORGE",
"middle_name": "MARIO",
"credential": "CERTIFED PSYCHOLOGIC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-01-08",
"last_updated": "2008-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "KY",
"license": "0186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Somerset, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.