Provider Demographics
NPI:1629338082
Name:HOWARTH, MATTHEW (PHD, BCBA-D)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HOWARTH
Suffix:
Gender:M
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11250 PENANOVA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-1027
Mailing Address - Country:US
Mailing Address - Phone:858-603-6823
Mailing Address - Fax:
Practice Address - Street 1:11250 PENANOVA ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-1027
Practice Address - Country:US
Practice Address - Phone:858-603-6823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-20
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-08-4385103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst