Provider Demographics
NPI:1477814382
Name:JANNINI, MARTINE M (MAED BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MARTINE
Middle Name:M
Last Name:JANNINI
Suffix:
Gender:F
Credentials:MAED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 FROEHLICH PL
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2907
Mailing Address - Country:US
Mailing Address - Phone:516-851-6213
Mailing Address - Fax:
Practice Address - Street 1:518 FROEHLICH PL
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2907
Practice Address - Country:US
Practice Address - Phone:516-851-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1096590103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst