Provider Demographics
NPI:1861246571
Name:MARTINEZ, HANAYSA
Entity type:Individual
Prefix:
First Name:HANAYSA
Middle Name:
Last Name:MARTINEZ
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 1:1300 STONEWAY LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-5628
Mailing Address - Country:US
Mailing Address - Phone:561-420-3207
Mailing Address - Fax:
Practice Address - Street 1:7711 N MILITARY TRL # 1008
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6506
Practice Address - Country:US
Practice Address - Phone:561-461-7398
Practice Address - Fax:561-584-5836
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-341241106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst