Provider Demographics
NPI:1386319267
Name:MARTINEZ, CONSUELO DEL VALLE (RBT-21-173731)
Entity type:Individual
Prefix:
First Name:CONSUELO
Middle Name:DEL VALLE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RBT-21-173731
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 NW 208TH WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2159
Mailing Address - Country:US
Mailing Address - Phone:954-534-3460
Mailing Address - Fax:
Practice Address - Street 1:739 NW 208TH WAY
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2159
Practice Address - Country:US
Practice Address - Phone:954-534-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-173731106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician