Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 1-20-43730 | IL |
N | 106S00000X | Behavior Technician | 18-62680 | IL |
NPI | 1194204057 |
---|---|
Provider Name | Sara Martinez |
First Address | Batavia, IL 60510-2006 |
Second Address | North Aurora, IL 60542-5144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2018 |
Last Update Date | 14/05/2021 |