Provider Demographics
NPI:1639556137
Name:MATHEWS, BRANDON (BCABA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PIN OAK LN STE 250
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1630
Mailing Address - Country:US
Mailing Address - Phone:856-669-0211
Mailing Address - Fax:
Practice Address - Street 1:2 PIN OAK LN STE 250
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1630
Practice Address - Country:US
Practice Address - Phone:856-669-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0-14-5825103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst