Healthcare Provider Details

I. General information

NPI: 1942974399
Provider Name (Legal Business Name): MICHAELA HERMES MARTIN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2021
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 AUBURN DR STE 200
BEACHWOOD OH
44122-4328
US

IV. Provider business mailing address

1901 CRIDER RD
MANSFIELD OH
44903-9272
US

V. Phone/Fax

Practice location:
  • Phone: 888-830-1672
  • Fax:
Mailing address:
  • Phone: 419-239-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: