Healthcare Provider Details

I. General information

NPI: 1598094716
Provider Name (Legal Business Name): YESENIA MARTINEZ B.C.A.B.A ,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YESENIA RODRIGUEZ LMHC, B.C.A.B.A

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 NW 99TH PL
DORAL FL
33178-1950
US

IV. Provider business mailing address

4880 NW 99TH PL
DORAL FL
33178-1950
US

V. Phone/Fax

Practice location:
  • Phone: 305-778-8356
  • Fax:
Mailing address:
  • Phone: 305-778-8356
  • Fax: 305-597-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-07-2324
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12798
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: