Provider Demographics
NPI:1972841492
Name:STIEG, MATTHEW DAVID (MS, BCBA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:STIEG
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 1:9804 BODEGO WAY
Mailing Address - Street 2:#105
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9756
Mailing Address - Country:US
Mailing Address - Phone:239-896-8140
Mailing Address - Fax:
Practice Address - Street 1:9804 BODEGO WAY
Practice Address - Street 2:#105
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9756
Practice Address - Country:US
Practice Address - Phone:239-896-8140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst