Provider Demographics
NPI:1588016216
Name:MARTINEZ, BEATRIZ (BCBA)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name: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 1:6841 SW 147TH AVE APT 2H
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1006
Mailing Address - Country:US
Mailing Address - Phone:786-740-1229
Mailing Address - Fax:
Practice Address - Street 1:6841 SW 147TH AVE APT 2H
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1006
Practice Address - Country:US
Practice Address - Phone:786-740-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FL0-19-9990106E00000X
FLBCBA1-19-40125103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017583800Medicaid