Martin, Gary Roy
Martin, Gary Roy is an sole proprietor health care provider with primary practice located at 1 Pine St , Burlington VT 05401-4422. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Forensic, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Forensic is his primary health care specialty. Martin, Gary Roy can be contacted via phone (802) 862-1511.Contact Information
Primary practice address
1 Pine St
Burlington VT 05401-4422
Phone: (802) 862-1511
Fax: (802) 862-7059
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Forensic | 103TF0200X | Vermont | |
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | Vermont |
Profile Details
| NPI number | 1912063447 |
|---|---|
| LBN Legal business name | Martin, Gary Roy |
| Credentials | MSW, PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 29th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912063447 | NPPES |
| Vermont | Other | 062-5119 | BLUE CROSS BLUE SHIELD |
| Vermont | MEDICAID | 0005119 | BLUE CROSS BLUE SHIELD |
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