Provider Demographics
NPI:1487002648
Name:AMAT, MARINA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:AMAT
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 1:19001 NE 14TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4086
Mailing Address - Country:US
Mailing Address - Phone:305-967-9945
Mailing Address - Fax:
Practice Address - Street 1:19001 NE 14TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4086
Practice Address - Country:US
Practice Address - Phone:305-967-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-28
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-17-7861106E00000X
FL1-21-48223103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017671100Medicaid