Provider Demographics
NPI:1972298305
Name:MARTINEZ, CHANTEL M (RBT)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:M
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 1:10600 4TH ST N APT 1112
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3292
Mailing Address - Country:US
Mailing Address - Phone:727-318-8148
Mailing Address - Fax:
Practice Address - Street 1:1258 W BAY DR STE F
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2240
Practice Address - Country:US
Practice Address - Phone:727-641-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-268239106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician