Provider Demographics
NPI:1962067397
Name:MARTINEZ TACORONTE, ANET (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ANET
Middle Name:
Last Name:MARTINEZ TACORONTE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 SW 103RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1377
Mailing Address - Country:US
Mailing Address - Phone:305-930-9811
Mailing Address - Fax:
Practice Address - Street 1:7108 SW 103RD PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1377
Practice Address - Country:US
Practice Address - Phone:305-930-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-20-11660106E00000X
FLRBT-18-55283106S00000X
FL1-22-57830103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103005700Medicaid