Provider Demographics
NPI:1225420565
Name:MATTERS, JERALD DONALD (BCBA)
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:DONALD
Last Name:MATTERS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8565 FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4815
Mailing Address - Country:US
Mailing Address - Phone:703-853-3599
Mailing Address - Fax:
Practice Address - Street 1:8565 FAIRFAX ST
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4815
Practice Address - Country:US
Practice Address - Phone:703-853-3599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst