Provider Demographics
NPI:1114488822
Name:MARTIN, DANIELLE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 ALT A1A STE 114-116
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2205
Mailing Address - Country:US
Mailing Address - Phone:561-436-9283
Mailing Address - Fax:561-209-0021
Practice Address - Street 1:12300 ALT A1A STE 114-116
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2205
Practice Address - Country:US
Practice Address - Phone:561-436-9283
Practice Address - Fax:561-209-0021
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S0000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician