Provider Demographics
NPI:1619356557
Name:GARRETT, MATTHEW R (BCBA, AMFT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:GARRETT
Suffix:
Gender:M
Credentials:BCBA, AMFT
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:R
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA, AMFT
Mailing Address - Street 1:3021 TELEGRAPH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2072
Mailing Address - Country:US
Mailing Address - Phone:925-989-5796
Mailing Address - Fax:
Practice Address - Street 1:3021 TELEGRAPH AVE STE C
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2072
Practice Address - Country:US
Practice Address - Phone:510-974-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-24644103K00000X
CA131012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst