Provider Demographics
NPI:1508632845
Name:MENDOZA, MATTHEW GARCIA (BCBA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GARCIA
Last Name:MENDOZA
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 1:4752 N OPAL AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-4406
Mailing Address - Country:US
Mailing Address - Phone:630-209-0268
Mailing Address - Fax:
Practice Address - Street 1:666 DUNDEE RD STE 1605
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2738
Practice Address - Country:US
Practice Address - Phone:847-495-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-23-69848103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst