MEDICARE: LARRY MATTHEW MCNEILL MPM

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		NC

General Provider Information

NPI Number	:	1841145034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY MATTHEW MCNEILL MPM

Provider Business Mailing Address
First Line	:	808 HARRY WEST LN
Second Line	:
City	:	PEMBROKE
State	:	NC
Zip	:	28372-9418
Country	:	US
Telephone Number	:	910-536-6043
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 CAMBRIDGE ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5300
Country	:	US
Telephone Number	:	910-493-3555
Fax Number	:

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

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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