Basic Information
| Provider Information | |||||||||
| NPI: | 1952637159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FITTRO | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8001 SW 36TH ST | ||||||||
| Address2: | SUITE 9 | ||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333281915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545777790 | ||||||||
| FaxNumber: | 9545777780 | ||||||||
| Practice Location | |||||||||
| Address1: | 8001 SW 36TH ST | ||||||||
| Address2: | SUITE 9 | ||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333281915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545777790 | ||||||||
| FaxNumber: | 9545777780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2009 | ||||||||
| LastUpdateDate: | 10/22/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-08-4619 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.