Provider Demographics
NPI:1114430428
Name:DEL ROSARIO, MATTHEW (CBT, RBT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DEL ROSARIO
Suffix:
Gender:M
Credentials:CBT, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 E SPOKANE FALLS BLVD STE 14
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-5081
Mailing Address - Country:US
Mailing Address - Phone:509-328-1582
Mailing Address - Fax:877-376-3335
Practice Address - Street 1:3170 DE LA CRUZ BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-2411
Practice Address - Country:US
Practice Address - Phone:408-423-8076
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
WARBT-18-50175103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst