Provider Demographics
NPI:1881236875
Name:MARTIN, DEREK VINCENT (MM, BCBA, LBS)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:VINCENT
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MM, BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 OREGON PIKE STE 2
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6466
Mailing Address - Country:US
Mailing Address - Phone:888-805-8206
Mailing Address - Fax:
Practice Address - Street 1:1821 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6466
Practice Address - Country:US
Practice Address - Phone:888-805-8206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH004643103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst