Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106E00000X | Assistant Behavior Analyst | M635-781-93-724-0 | FL |
NPI | 1073056792 |
---|---|
Provider Name | Stephanie Martinez |
First Address | Port Saint Lucie, FL 34987-2312 |
Second Address | Port Saint Lucie, FL 34953-2845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2016 |
Last Update Date | 22/06/2020 |