Provider Demographics
NPI:1912651001
Name:AVELLANEDA, MARTIN JR
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:AVELLANEDA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 FORT MEADE RD
Mailing Address - Street 2:
Mailing Address - City:FROSTPROOF
Mailing Address - State:FL
Mailing Address - Zip Code:33843-9531
Mailing Address - Country:US
Mailing Address - Phone:863-605-4616
Mailing Address - Fax:
Practice Address - Street 1:244 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-3706
Practice Address - Country:US
Practice Address - Phone:863-605-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health