Provider Demographics
NPI:1144624636
Name:MARTIN J. SCHOEN, PSY.D., L.L.C.
Entity type:Organization
Organization Name:MARTIN J. SCHOEN, PSY.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHOEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:651-503-9852
Mailing Address - Street 1:PO BOX 130891
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-0008
Mailing Address - Country:US
Mailing Address - Phone:651-503-9852
Mailing Address - Fax:651-788-9554
Practice Address - Street 1:2096 FAIRWAYS LN
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-3813
Practice Address - Country:US
Practice Address - Phone:651-503-9852
Practice Address - Fax:651-788-9554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN680003444OtherMEDICARE PROVIDER NUMBER