Provider Demographics
NPI:1598094716
Name:MARTINEZ, YESENIA (BCABA ,)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BCABA ,
Other - Prefix:MRS
Other - First Name:YESENIA
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC, BCABA
Mailing Address - Street 1:4880 NW 99TH PL
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1950
Mailing Address - Country:US
Mailing Address - Phone:305-778-8356
Mailing Address - Fax:305-597-3863
Practice Address - Street 1:4880 NW 99TH PL
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-1950
Practice Address - Country:US
Practice Address - Phone:305-778-8356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-07-2324103K00000X
FLMH12798101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst