Provider Demographics
NPI:1720546435
Name:MATZKE, BROOKE (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:MATZKE
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SEVENTY ACRE RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-2703
Mailing Address - Country:US
Mailing Address - Phone:860-539-8335
Mailing Address - Fax:
Practice Address - Street 1:900 ETHAN ALLEN HWY
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-2826
Practice Address - Country:US
Practice Address - Phone:475-231-0774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000761103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst