Provider Demographics
NPI:1003219908
Name:MARTINEZ, MALENA SUAREZ (BCBA)
Entity Type:Individual
Prefix:
First Name:MALENA
Middle Name:SUAREZ
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 S COMMERCE PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3622
Mailing Address - Country:US
Mailing Address - Phone:954-385-6200
Mailing Address - Fax:954-385-6289
Practice Address - Street 1:2900 S COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3622
Practice Address - Country:US
Practice Address - Phone:954-385-6200
Practice Address - Fax:954-385-6289
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-14-16427103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010060900Medicaid