MEDICARE: ELISABETH MATHEWSON MA, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	1-15-20131
2	103K00000X	Behavior Analyst	11520131	CA

General Provider Information

NPI Number	:	1063884948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISABETH MATHEWSON MA, BCBA

Provider Business Mailing Address
First Line	:	4641 POST ST UNIT 5287
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-3012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4641 POST ST UNIT 5287
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-3012
Country	:	US
Telephone Number	:	530-355-5137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	02/16/2025

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