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General NPI Number Information
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NPI Number | 1700285996
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Entity Type | Organization
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Legal Business Name | MARTINEZ BEHAVIOR MANAGEMENT SERVICES
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 3723 GURLEY RD
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City | JACKSONVILLE
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State | FL
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Zip | 32277-2012
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Country | US
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Telephone | 904-445-9732
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Fax |
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Provider Business Mailing Address
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Address Line | 3723 GURLEY RD
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City | JACKSONVILLE
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State | FL
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Zip | 32277-2012
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Country | US
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Telephone | 904-445-9732
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | CAROLYN E MARTINEZ
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Credential | BCBA
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Telephone | 904-445-9732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1-01-0583
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License Number State | FL
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