Provider Demographics
NPI:1558991729
Name:MARTIN, NATALIE JANE (MED, BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:JANE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SEABREEZE AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-7932
Mailing Address - Country:US
Mailing Address - Phone:203-605-2624
Mailing Address - Fax:
Practice Address - Street 1:128 SEABREEZE AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-7932
Practice Address - Country:US
Practice Address - Phone:203-605-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000907103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst