Provider Demographics
NPI:1528940178
Name:MARTINS, KENECHI (LBS)
Entity type:Individual
Prefix:
First Name:KENECHI
Middle Name:
Last Name:MARTINS
Suffix:
Gender:M
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 SNYDER AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-5521
Mailing Address - Country:US
Mailing Address - Phone:302-747-4776
Mailing Address - Fax:
Practice Address - Street 1:1107 SNYDER AVE APT 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-5521
Practice Address - Country:US
Practice Address - Phone:302-747-4776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH007795106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst