Provider Demographics
NPI:1366243495
Name:MARTIN, CALLIE (RBT)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KAI
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:1800 NEW JERSEY 34
Mailing Address - Street 2:BUILDING NO. 3, SUITE 301B
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719
Mailing Address - Country:US
Mailing Address - Phone:732-749-8317
Mailing Address - Fax:
Practice Address - Street 1:1800 NEW JERSEY 34
Practice Address - Street 2:BUILDING NO. 3, SUITE 301B
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719
Practice Address - Country:US
Practice Address - Phone:732-749-8317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-25-416218106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician