Healthcare Provider Details

I. General information

NPI: 1477330876
Provider Name (Legal Business Name): MATTHEW CHARLES ECCLESTON BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MATTHEW ECCLESTON

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ALBION RD STE 320
LINCOLN RI
02865-3744
US

IV. Provider business mailing address

1333 S MAYFLOWER AVE STE 220
MONROVIA CA
91016-5239
US

V. Phone/Fax

Practice location:
  • Phone: 855-295-3276
  • Fax: 888-588-2752
Mailing address:
  • Phone: 818-241-6780
  • Fax: 888-588-2752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA00374
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-66835
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: