Provider Demographics
NPI:1134755853
Name:GERENA, MARTINA Y (BCBA)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:Y
Last Name:GERENA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MARTINA
Other - Middle Name:Y
Other - Last Name:VINCI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:321-277-8548
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:7948 FOREST CITY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-2907
Practice Address - Country:US
Practice Address - Phone:689-208-2208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-113092106S00000X
FL1-21-51563103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician