Provider Demographics
NPI:1679848725
Name:MARTIN, BRENTON RAY (MS)
Entity type:Individual
Prefix:MR
First Name:BRENTON
Middle Name:RAY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8 W BLOOMFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-5170
Mailing Address - Country:US
Mailing Address - Phone:814-824-4515
Mailing Address - Fax:814-824-4533
Practice Address - Street 1:8 W BLOOMFIELD PKWY
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-5170
Practice Address - Country:US
Practice Address - Phone:814-824-4515
Practice Address - Fax:814-824-4533
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst