Provider Demographics
NPI:1407252190
Name:MATTHEW, WILLIAM (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MATTHEW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 DEERFIELD ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-9690
Mailing Address - Country:US
Mailing Address - Phone:661-978-9238
Mailing Address - Fax:
Practice Address - Street 1:1919 DEERFIELD ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93314-9690
Practice Address - Country:US
Practice Address - Phone:661-978-9238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-05-2336103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-05-2336OtherBEHAVIOR ANALYST CERTIFICATION BOARD
FL1-05-2336OtherBEHAVIOR ANALYST CERTIFICATION BOARD