Provider Demographics
NPI:1487864849
Name:MARTINEZ, YANET (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:YANET
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2891 SW 136TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6641
Mailing Address - Country:US
Mailing Address - Phone:305-303-5588
Mailing Address - Fax:
Practice Address - Street 1:2891 SW 136TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6641
Practice Address - Country:US
Practice Address - Phone:305-303-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2019-02-20
Deactivation Date:2019-01-25
Deactivation Code:
Reactivation Date:2019-02-15
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
FL1-18-33261103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator