MEDICARE: KENECHI MARTINS LBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst	BH007795	PA

General Provider Information

NPI Number	:	1528940178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENECHI MARTINS LBS

Provider Business Mailing Address
First Line	:	1107 SNYDER AVE APT 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-5521
Country	:	US
Telephone Number	:	302-747-4776
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 SNYDER AVE APT 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-5521
Country	:	US
Telephone Number	:	302-747-4776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2025
Last Update Date	:	07/24/2025

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Directions to “ KENECHI MARTINS LBS” Practice Location

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