Individual
EBONY VANESSA MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24451 LAKESHORE BLVD, APT 1216 UNIT 2, EUCLID, OH 44123-4412
(216) 290-8257
Mailing address
24451 LAKESHORE BLVD, APT 1216 UNIT 2, EUCLID, OH 44123
(216) 290-8257
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
910000570569
—
OH
Enumeration date
01/26/2023
Last updated
01/26/2023
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