Provider Demographics
NPI:1912455528
Name:CASSANDRA MARTINEZ, LICENSED BEHAVIOR ANALYST
Entity Type:Organization
Organization Name:CASSANDRA MARTINEZ, LICENSED BEHAVIOR ANALYST
Other - Org Name:PRECISION ABA THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA, LMSW
Authorized Official - Phone:516-852-0688
Mailing Address - Street 1:12 TIDEWATER AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-8423
Mailing Address - Country:US
Mailing Address - Phone:516-852-0688
Mailing Address - Fax:
Practice Address - Street 1:12 TIDEWATER AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-8423
Practice Address - Country:US
Practice Address - Phone:516-852-0688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000036251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health