Provider Demographics
NPI:1982116570
Name:SABO, MATTHEW DENNIS (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DENNIS
Last Name:SABO
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 LINDIS LN APT 3
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-3023
Mailing Address - Country:US
Mailing Address - Phone:517-614-2047
Mailing Address - Fax:
Practice Address - Street 1:910 LINDIS LN APT 3
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-3023
Practice Address - Country:US
Practice Address - Phone:517-614-2047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-13298103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst