Provider Demographics
NPI:1982923447
Name:MATHEWS, GRETCHEN (BCBA)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8267 YARDLEY AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-3667
Mailing Address - Country:US
Mailing Address - Phone:727-742-8697
Mailing Address - Fax:800-981-5129
Practice Address - Street 1:8267 YARDLEY AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710
Practice Address - Country:US
Practice Address - Phone:727-742-8697
Practice Address - Fax:800-981-5129
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-5110103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst