Provider Demographics
NPI:1720500234
Name:MARTINEZ, DEIRDRE MARY (BCBA)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:MARY
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7313 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2215
Mailing Address - Country:US
Mailing Address - Phone:720-217-5136
Mailing Address - Fax:
Practice Address - Street 1:2525 S WADSWORTH BLVD STE 303
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-3246
Practice Address - Country:US
Practice Address - Phone:720-962-4555
Practice Address - Fax:720-962-4466
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-16-23249103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst