Matthew Garcia Mendoza, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-23-69848 Issued in IL

Practice address

4250 Sunrise Hwy Ste 206
Massapequa, NY 11758-5344

Phone

(516) 324-6380

NPI assigned

Nov 28, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Marissa Bennett Consulting, LLC

  • Behavior Analyst
  • Northbrook, IL
  • NPI 1003466186
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1508632845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4752 N OPAL AVE",
            "city": "NORRIDGE",
            "state": "IL",
            "postal_code": "607064406",
            "telephone_number": "630-209-0268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 SUNRISE HWY STE 206",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117585344",
            "telephone_number": "516-324-6380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "666 Dundee Rd Ste 1605",
            "address_purpose": "LOCATION",
            "city": "Northbrook",
            "state": "IL",
            "postal_code": "600622738",
            "country_code": "US",
            "telephone_number": "847-495-2640",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "MATTHEW",
        "middle_name": "GARCIA",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-11-28",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "IL",
            "license": "1-23-69848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Massapequa, NY
• Providers in Massapequa, NY by specialty
• Behavior Analyst in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.