Individual provider Active NPI

Marianela Pena-Martinez

  • Psychologist
  • Davie, FL
National Provider Identifier
1780967554
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
4801 S University Dr Ste 303
Davie, FL 33328-3841
Phone
(754) 304-6378
Fax
(954) 642-1213
NPI assigned
Sep 27, 2011
Last updated
Mar 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU Primary
Developmental Therapist 222Q00000X NU

Addresses

Primary practice location

4801 S University Dr Ste 303
Davie, FL 33328-3841

Mailing address

4801 S University Dr Ste 303
Davie, FL 33328-3841
Phone (754) 304-6378

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240124001001 FL Practitioner - Clinical Psychologist 5294188488 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

4801 S University Dr
Suite 303
Davie, FL 33328-3841
Phone (754) 304-6378

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Now Change Center, LLC Psychologist CurrentSince Dec 19, 2023 Accepting new patients

Locations

4801 S University Dr
Ste 303
Davie, FL 33328
Phone (754) 304-6378

1725 Main St
Ste 223
Weston, FL 33326
Phone (754) 778-5705

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743033600000",
    "number": "1780967554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 S UNIVERSITY DR STE 303",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333283841",
            "telephone_number": "754-304-6378",
            "fax_number": "954-642-1213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 S UNIVERSITY DR STE 303",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333283841",
            "telephone_number": "754-304-6378",
            "fax_number": "954-642-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA-MARTINEZ",
        "first_name": "MARIANELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-27",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davie, FL

Sources for this page

Verify at the official NPI Registry.