Provider Demographics
NPI:1851635023
Name:MARTINEZ, BERENICE (MA BCBA)
Entity Type:Individual
Prefix:
First Name:BERENICE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6923 N LOMA DR
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-5601
Mailing Address - Country:US
Mailing Address - Phone:956-351-9427
Mailing Address - Fax:
Practice Address - Street 1:6923 N LOMA DR
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-5601
Practice Address - Country:US
Practice Address - Phone:956-351-9427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-11770103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst