Provider Demographics
NPI:1922693191
Name:MARTIN, COURTNEY RENEE (BCBA, LBS)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:RENEE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-1238
Mailing Address - Country:US
Mailing Address - Phone:724-601-7612
Mailing Address - Fax:
Practice Address - Street 1:833 MEADOW AVE
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-1238
Practice Address - Country:US
Practice Address - Phone:724-601-7612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-20-44852103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst