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NPI Code Detail

MEDICARE: BRANDON MATHEWS BCABA

MEDICARE: BRANDON MATHEWS BCABA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst0-14-5825NJ

General Provider Information

NPI Number : 1639556137
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON MATHEWS BCABA
Provider Business Mailing Address
First Line : 2 PIN OAK LN STE 250
Second Line :
City : CHERRY HILL
State : NJ
Zip : 08003-1630
Country : US
Telephone Number : 856-669-0211
Fax Number :
Provider Business Practice Location Address
First Line : 2 PIN OAK LN STE 250
Second Line :
City : CHERRY HILL
State : NJ
Zip : 08003-1630
Country : US
Telephone Number : 856-669-0211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2015
Last Update Date : 05/04/2015

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