Provider Demographics
NPI:1851058168
Name:MARTINEZ, SHAUNA (RBT)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5906 S 169TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-2813
Mailing Address - Country:US
Mailing Address - Phone:402-812-5975
Mailing Address - Fax:402-891-8860
Practice Address - Street 1:5906 S 169TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-2813
Practice Address - Country:US
Practice Address - Phone:402-812-5975
Practice Address - Fax:402-891-8860
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NERBT-21-186611106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NERBT-21-186611OtherBACB