Provider Demographics
NPI:1588024590
Name:FLAKE, MARTINE (BCABA)
Entity Type:Individual
Prefix:
First Name:MARTINE
Middle Name:
Last Name:FLAKE
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MCCLURE DR
Mailing Address - Street 2:UNIT B
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7426
Mailing Address - Country:US
Mailing Address - Phone:850-777-6764
Mailing Address - Fax:
Practice Address - Street 1:3182 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3248
Practice Address - Country:US
Practice Address - Phone:850-932-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst