Provider Demographics
NPI:1184372476
Name:MARTINEZ, KEILYN DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:KEILYN
Middle Name:DE LA CARIDAD
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEILYN
Other - Middle Name:DE LA CARIDAD
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:KEILYN MARTINEZ
Mailing Address - Street 1:7396 W 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3711
Mailing Address - Country:US
Mailing Address - Phone:786-394-3752
Mailing Address - Fax:
Practice Address - Street 1:7396 W 18TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3711
Practice Address - Country:US
Practice Address - Phone:786-394-3752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-119318106S00000X
FL1-24-75102103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107251600Medicaid