Provider Demographics
NPI:1124539747
Name:MARTINEZ, DACHELY (RBT -)
Entity type:Individual
Prefix:MS
First Name:DACHELY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RBT -
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 NW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-6436
Mailing Address - Country:US
Mailing Address - Phone:305-393-9359
Mailing Address - Fax:
Practice Address - Street 1:3044 NW 29TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-6436
Practice Address - Country:US
Practice Address - Phone:305-393-9359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4525241Medicaid