=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710456850
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW GERARD SINKEWICZ MA, BCBA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2018
-----------------------------------------------------
Last Update Date | 11/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 427 NAUBUC AVE
-----------------------------------------------------
City | GLASTONBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06033-1082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-367-1999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 GOLDBERG RD
-----------------------------------------------------
City | COLCHESTER
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06415-2145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-367-1999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------