Provider Demographics
NPI:1699189316
Name:MCAVOY, MATTHEW (BCBA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MCAVOY
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 1:675 MAIN ST STE 19
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5872
Mailing Address - Country:US
Mailing Address - Phone:207-783-7473
Mailing Address - Fax:
Practice Address - Street 1:675 MAIN ST STE 19
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5872
Practice Address - Country:US
Practice Address - Phone:207-783-7473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1-13-13169103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst