Provider Demographics
NPI:1124564810
Name:HIMMIGHOEFER, MATTHEW (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HIMMIGHOEFER
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1860
Mailing Address - Country:US
Mailing Address - Phone:884-428-8476
Mailing Address - Fax:
Practice Address - Street 1:13 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1860
Practice Address - Country:US
Practice Address - Phone:884-428-8476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MABACB229641103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst