MEDICARE: DANIELLE MARTIN 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	103K00000X	Behavior Analyst	0133000758	VA

General Provider Information

NPI Number	:	1881043586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE MARTIN BCBA

Provider Business Mailing Address
First Line	:	21600 OXNARD ST
Second Line	:	SUITE 1800
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4976
Country	:	US
Telephone Number	:	818-345-2345
Fax Number	:	818-449-0994

Provider Business Practice Location Address
First Line	:	820 GREENBRIER CIR
Second Line	:	SUITE 32
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-2646
Country	:	US
Telephone Number	:	818-345-2345
Fax Number	:	818-449-0994

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

Provider Enumeration Date	:	06/03/2016
Last Update Date	:	06/03/2016

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