Provider Demographics
NPI:1467822932
Name:MARTEL, TAYLOR PAIGE (BCBA, MED, LBA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:PAIGE
Last Name:MARTEL
Suffix:
Gender:F
Credentials:BCBA, MED, LBA
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:PAIGE
Other - Last Name:ISLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 VILLAGE SQ STE 210
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1624
Mailing Address - Country:US
Mailing Address - Phone:609-525-4271
Mailing Address - Fax:443-743-3863
Practice Address - Street 1:14059 CROWN CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1458
Practice Address - Country:US
Practice Address - Phone:866-565-7222
Practice Address - Fax:877-734-1914
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-18-29695103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1467822932Medicaid