MEDICARE: LISA JOYCE MARTINEZ BCBA

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	0-23-14384	TX
2	106S00000X	Behavior Technician	RBT-21-151400	TX
3	2355S0801X	Speech-Language Assistant	34564	TX
4	103K00000X	Behavior Analyst	1-23-69553	TX

General Provider Information

NPI Number	:	1619461076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA JOYCE MARTINEZ BCBA

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 S 10TH ST
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78501-5059
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

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

Provider Enumeration Date	:	06/19/2018
Last Update Date	:	12/05/2023

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