Basic Information
| Provider Information | |||||||||
| NPI: | 1114386356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEAU | ||||||||
| FirstName: | KARLEE | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MARTINEAU | ||||||||
| OtherFirstName: | KARLEE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 500 FAIRWAY DR STE 102 | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334411817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888809270 | ||||||||
| FaxNumber: | 9543420273 | ||||||||
| Practice Location | |||||||||
| Address1: | 4201 N I 10 SERVICE RD W | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700066713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546037885 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2016 | ||||||||
| LastUpdateDate: | 12/28/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-18-31811 | LA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.