Provider Demographics
NPI:1497447056
Name:BACKUS, MARTI MARIA (MA)
Entity type:Individual
Prefix:MS
First Name:MARTI
Middle Name:MARIA
Last Name:BACKUS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 GOVERNORS RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03851-4757
Mailing Address - Country:US
Mailing Address - Phone:802-825-6187
Mailing Address - Fax:
Practice Address - Street 1:619 GOVERNORS RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:NH
Practice Address - Zip Code:03851-4757
Practice Address - Country:US
Practice Address - Phone:802-825-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health