Provider Demographics
NPI:1649697020
Name:PRICE-MARTINEZ, LEATHA (MA BCBA LBA)
Entity type:Individual
Prefix:
First Name:LEATHA
Middle Name:
Last Name:PRICE-MARTINEZ
Suffix:
Gender:F
Credentials:MA BCBA LBA
Other - Prefix:
Other - First Name:LEATHA
Other - Middle Name:
Other - Last Name:HUNTINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA BCBA LBA
Mailing Address - Street 1:9600 NW 25TH ST STE PH
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1416
Mailing Address - Country:US
Mailing Address - Phone:305-597-3861
Mailing Address - Fax:305-597-3863
Practice Address - Street 1:9600 NW 25TH ST STE PH
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172
Practice Address - Country:US
Practice Address - Phone:305-597-3861
Practice Address - Fax:305-597-3863
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-14-15394103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst