Provider Demographics
NPI:1174286496
Name:MARTINEZ SOCARRAS, KARIETY
Entity Type:Individual
Prefix:
First Name:KARIETY
Middle Name:
Last Name:MARTINEZ SOCARRAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4757 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2546
Mailing Address - Country:US
Mailing Address - Phone:305-252-4631
Mailing Address - Fax:305-232-6809
Practice Address - Street 1:4757 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2546
Practice Address - Country:US
Practice Address - Phone:305-252-4631
Practice Address - Fax:305-232-6809
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-128154106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107553000Medicaid