Provider Demographics
NPI:1790345072
Name:CONE, SHANE MATTHEW (BCBA)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:MATTHEW
Last Name:CONE
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 1:567 AUTO CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3727
Mailing Address - Country:US
Mailing Address - Phone:831-332-4441
Mailing Address - Fax:
Practice Address - Street 1:567 AUTO CENTER DR
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3727
Practice Address - Country:US
Practice Address - Phone:831-332-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-36040103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst