Healthcare Provider Details

I. General information

NPI: 1619481900
Provider Name (Legal Business Name): MATTHEW TAYLOR M.A., BCBA, LBA-V
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 VINE ST
WAYNESBORO VA
22980-1827
US

IV. Provider business mailing address

233 VINE ST
WAYNESBORO VA
22980-1827
US

V. Phone/Fax

Practice location:
  • Phone: 919-880-7220
  • Fax:
Mailing address:
  • Phone: 919-880-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number0133001035
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133001035
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: