Most Relevant Information
Provider Data
| NPI Number: | 1003280777 |
| Provider Name: | MATTHEW JAMES BLAZEK BCBA |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/18/2015 |
| Last Updated: | 08/17/2021 |
Provider Practice Location
42 BAR HARBOR TER
CHARLES TOWN
WV
254141216
Practice Location Phone/Fax
| Phone: | 4159903608 |
| Fax: |
Provider Mailing Location
42 BAR HARBOR TER
CHARLES TOWN
WV
254141216
Provider Mailing Phone/Fax
| Phone: | 4159903608 |
| Fax: |