Provider Demographics
NPI:1598403198
Name:MARTINEZ, KELLY (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
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 1:68 WOODRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03826-2405
Mailing Address - Country:US
Mailing Address - Phone:978-479-5090
Mailing Address - Fax:
Practice Address - Street 1:68 WOODRIDGE RD
Practice Address - Street 2:
Practice Address - City:EAST HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03826-2405
Practice Address - Country:US
Practice Address - Phone:978-479-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHBACB559898103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHBACB559898OtherBACB
NH109970OtherSTATE OF NH BOARD OF EDUCATION