Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-21-53907 | FL |
N | 106E00000X | Assistant Behavior Analyst | FL | |
N | 106E00000X | Assistant Behavior Analyst | 0-19-10095 | FL |
NPI | 1093355380 |
---|---|
Provider Name | Madelin I Fernandez Martell |
First Address | Miami, FL 33177-7126 |
Second Address | Homestead, FL 33035-1173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2020 |
Last Update Date | 04/10/2021 |