Provider Demographics
NPI:1548967029
Name:MARTINEZ, DEANGELO JAMES (BCBA)
Entity type:Individual
Prefix:
First Name:DEANGELO
Middle Name:JAMES
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 VALLEJO ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-1361
Mailing Address - Country:US
Mailing Address - Phone:720-227-4506
Mailing Address - Fax:
Practice Address - Street 1:1 INVERNESS DR E
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5519
Practice Address - Country:US
Practice Address - Phone:303-578-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-23-63807103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst