Provider Demographics
NPI:1538757158
Name:ALEJANDRO, MARTHA LYDIA (RBT)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:LYDIA
Last Name:ALEJANDRO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3678 RIDGE CLUSTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3454
Mailing Address - Country:US
Mailing Address - Phone:210-861-8421
Mailing Address - Fax:
Practice Address - Street 1:3678 RIDGE CLUSTER ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3454
Practice Address - Country:US
Practice Address - Phone:210-861-8421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician