Provider Demographics
NPI:1487997870
Name:GILMARTIN, ELAINE MARGARITA (BCBA)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARGARITA
Last Name:GILMARTIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:MARGARITA
Other - Last Name:MACIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1791 NE MIAMI GARDENS DR APT 604
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5380
Mailing Address - Country:US
Mailing Address - Phone:626-673-9566
Mailing Address - Fax:
Practice Address - Street 1:2708 NE 14TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062
Practice Address - Country:US
Practice Address - Phone:888-880-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FL1-17-27518103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist