Provider Demographics
NPI:1427342823
Name:GUTIERREZ, MARTA ALBACETE
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:ALBACETE
Last Name:GUTIERREZ
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 1:6821 SW 147TH AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1002
Mailing Address - Country:US
Mailing Address - Phone:917-846-2212
Mailing Address - Fax:
Practice Address - Street 1:6821 SW 147TH AVE APT 2D
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1002
Practice Address - Country:US
Practice Address - Phone:917-846-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
1-22-62960103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst