Provider Demographics
NPI:1497821532
Name:MATHIEU, RAY (BCBA)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:MATHIEU
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 1:7641 TAHITI LN APT 106
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-4943
Mailing Address - Country:US
Mailing Address - Phone:561-714-7737
Mailing Address - Fax:
Practice Address - Street 1:7641 TAHITI LN APT 106
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-4943
Practice Address - Country:US
Practice Address - Phone:561-714-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-05-1867101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional