Provider Demographics
NPI:1447765284
Name:AYALA-MARTINEZ, LENA MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:MARIE
Last Name:AYALA-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 1:7604 TAPPER AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-3021
Mailing Address - Country:US
Mailing Address - Phone:219-218-8114
Mailing Address - Fax:
Practice Address - Street 1:18324 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3403
Practice Address - Country:US
Practice Address - Phone:224-801-1717
Practice Address - Fax:888-874-9552
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-27703103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst