Provider Demographics
NPI:1316834872
Name:MARTINEZ CASANOLA, DELLYS DANEYDA
Entity type:Individual
Prefix:
First Name:DELLYS
Middle Name:DANEYDA
Last Name:MARTINEZ CASANOLA
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 1:2328 10TH AVE N STE 501G
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6615
Mailing Address - Country:US
Mailing Address - Phone:561-284-6425
Mailing Address - Fax:
Practice Address - Street 1:2328 10TH AVE N STE 501G
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-6615
Practice Address - Country:US
Practice Address - Phone:561-284-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-445835106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician