Individual
CARLOS MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSED
Contact information
Practice address
369 E 148TH ST, BRONX, NY 10455-4041
(718) 769-2698
(718) 764-6469
Mailing address
2180 WALLACE AVE, APT 3C, BRONX, NY 10462-1860
(718) 822-0127
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
754704
NY
Other
Enumeration date
07/21/2011
Last updated
09/30/2012
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