Provider Demographics
NPI:1639886690
Name:MARTINEZ, ELBA LIZETTE
Entity Type:Individual
Prefix:
First Name:ELBA
Middle Name:LIZETTE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CALABRIA AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3026
Mailing Address - Country:US
Mailing Address - Phone:786-569-2973
Mailing Address - Fax:
Practice Address - Street 1:115 CALABRIA AVE APT 6
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3026
Practice Address - Country:US
Practice Address - Phone:786-569-2973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-123592106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst