Provider Demographics
NPI:1356982482
Name:GREEN, MATTHEW (BCBA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:GREEN
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 1:6 CHENELL DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-8505
Mailing Address - Country:US
Mailing Address - Phone:603-224-8085
Mailing Address - Fax:603-225-7441
Practice Address - Street 1:6 CHENELL DR STE 150
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-8505
Practice Address - Country:US
Practice Address - Phone:603-224-8085
Practice Address - Fax:603-225-7441
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-19-37397103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst