Provider Demographics
NPI:1851913685
Name:VERDON, MATHEW T (BCBA)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:T
Last Name:VERDON
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 1:12780 WATERFORD LAKES PKWY STE 127
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4501
Mailing Address - Country:US
Mailing Address - Phone:407-276-2853
Mailing Address - Fax:407-598-5592
Practice Address - Street 1:12780 WATERFORD LAKES PKWY STE 127
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4501
Practice Address - Country:US
Practice Address - Phone:407-276-2853
Practice Address - Fax:407-598-5592
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-22-59285103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty