Healthcare Provider Details

I. General information

NPI: 1659209716
Provider Name (Legal Business Name): ALEXA MARTINEZ RBT-25-464622
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 CHARLSTOWNRD
NEW ALBANY IN
47150
US

IV. Provider business mailing address

1712 SPRING ST APT 7
JEFFERSONVILLE IN
47130-2907
US

V. Phone/Fax

Practice location:
  • Phone: 903-204-2414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberRBT-25-464622
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: