Provider Demographics
NPI:1851130447
Name:BAKER, MATHEW REID (RBT)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:REID
Last Name:BAKER
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 RUBIDOUX AVE
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-6040
Mailing Address - Country:US
Mailing Address - Phone:760-660-5413
Mailing Address - Fax:
Practice Address - Street 1:7315 RUBIDOUX AVE
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-6040
Practice Address - Country:US
Practice Address - Phone:760-660-5413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst