Provider Demographics
NPI:1457051674
Name:PENA MARTINEZ, LIANNY
Entity type:Individual
Prefix:
First Name:LIANNY
Middle Name:
Last Name:PENA MARTINEZ
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 1:1600 NE 1ST AVE APT 1105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1220
Mailing Address - Country:US
Mailing Address - Phone:786-312-0083
Mailing Address - Fax:
Practice Address - Street 1:1600 NE 1ST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1212
Practice Address - Country:US
Practice Address - Phone:786-312-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-262094106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician