Provider Demographics
NPI:1528490216
Name:MARTINEZ, CYNTHIA E (MS ED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:E
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS ED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2698 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4515
Mailing Address - Country:US
Mailing Address - Phone:917-496-6144
Mailing Address - Fax:
Practice Address - Street 1:2417 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4710
Practice Address - Country:US
Practice Address - Phone:516-778-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730174131174400000X
NY002277103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist