Provider Demographics
NPI:1902105448
Name:MARTINI, MICHAEL L
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:MARTINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 DROMS RD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-9739
Mailing Address - Country:US
Mailing Address - Phone:518-860-9421
Mailing Address - Fax:
Practice Address - Street 1:433 GEYSER RD
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-3022
Practice Address - Country:US
Practice Address - Phone:518-885-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)