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General NPI Number Information
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NPI Number | 1740798818
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Entity Type | Individual
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Provider Name | CHARLENA MATHIS
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Gender | Female
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Dates
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Enumeration Date | 01/11/2018
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 1404 DISSTON ST
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City | PHILADELPHIA
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State | PA
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Zip | 19111-4504
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Country | US
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Telephone | 215-801-5530
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Fax | 215-801-5530
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Provider Business Mailing Address
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Address Line | 1500 S DOUGLAS RD STE 230
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City | CORAL GABLES
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State | FL
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Zip | 33134-4108
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Country | US
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Telephone | 844-854-1116
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | LABA429
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License Number State | NV
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