Provider Demographics
NPI:1356124606
Name:MATT BEHAVIOR ANALYST CORP
Entity type:Organization
Organization Name:MATT BEHAVIOR ANALYST CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PITA LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-203-3715
Mailing Address - Street 1:2913 UTOPIA DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5860
Mailing Address - Country:US
Mailing Address - Phone:786-203-3715
Mailing Address - Fax:
Practice Address - Street 1:4000 HOLLYWOOD BLVD STE 555-S559
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6751
Practice Address - Country:US
Practice Address - Phone:786-203-3715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty