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NPI Code Detail

MEDICARE: METTE O MADSEN BCBA

MEDICARE: METTE O MADSEN 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
1103K00000XBehavior Analyst1-12-10105CA
2106H00000XMarriage & Family Therapist104912CA

General Provider Information

NPI Number : 1366716920
Entity Type Code : Individual
Provider Name (Legal Business Name) : METTE O MADSEN BCBA
Provider Business Mailing Address
First Line : 402 W BROADWAY STE 400
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-3554
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1942 EMBARCADERO
Second Line :
City : OAKLAND
State : CA
Zip : 94606-5213
Country : US
Telephone Number : 510-832-4383
Fax Number : 510-550-1981
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/29/2012
Last Update Date : 09/13/2024

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Directions to “ METTE O MADSEN BCBA” Practice Location

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