Provider Demographics
NPI:1972395259
Name:JOHNS, ROBERT MATTHEW (MA, NCSP, BCBA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MATTHEW
Last Name:JOHNS
Suffix:
Gender:M
Credentials:MA, NCSP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 LARKFIELD CTR # 246
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1408
Mailing Address - Country:US
Mailing Address - Phone:707-350-2736
Mailing Address - Fax:
Practice Address - Street 1:422 LARKFIELD CTR # 246
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1408
Practice Address - Country:US
Practice Address - Phone:707-350-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210044684103TS0200X
1-22-62366103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool