Provider Demographics
NPI:1699393058
Name:MARTINEZ HENRY, KENIA
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:
Last Name:MARTINEZ HENRY
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 1:1570 W 38TH PL UNIT 12
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7041
Mailing Address - Country:US
Mailing Address - Phone:786-615-2514
Mailing Address - Fax:
Practice Address - Street 1:12401 W OKEECHOBEE RD LOT 296
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-2938
Practice Address - Country:US
Practice Address - Phone:786-443-9033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-118867106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician