Healthcare Provider Details

I. General information

NPI: 1780442715
Provider Name (Legal Business Name): GORDON SCHWARTZ M.A., BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21045 N 9TH PL STE 204
PHOENIX AZ
85024-5635
US

IV. Provider business mailing address

2233 E HIGHLAND AVE UNIT 129
PHOENIX AZ
85016-4878
US

V. Phone/Fax

Practice location:
  • Phone: 480-740-4130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88063
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: