Provider Demographics
NPI:1023343894
Name:MATTISON, DONNA L (BCBA)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:L
Last Name:MATTISON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N BENJAMIN DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-1945
Mailing Address - Country:US
Mailing Address - Phone:610-733-7785
Mailing Address - Fax:610-436-1208
Practice Address - Street 1:207 N BENJAMIN DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-1945
Practice Address - Country:US
Practice Address - Phone:610-733-7785
Practice Address - Fax:610-436-1208
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-04-1943OtherBEHAVIOR ANALYST CERTIFICATION BOARD