Provider Demographics
NPI:1316794621
Name:MARTINEZ ACOSTA, MASSIMO DAMIAN (RBT)
Entity type:Individual
Prefix:
First Name:MASSIMO
Middle Name:DAMIAN
Last Name:MARTINEZ ACOSTA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W 12TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4513
Mailing Address - Country:US
Mailing Address - Phone:786-603-8163
Mailing Address - Fax:
Practice Address - Street 1:12150 SW 128TH CT STE 125
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4672
Practice Address - Country:US
Practice Address - Phone:305-964-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT24342038106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician