Provider Demographics
NPI:1083429047
Name:RITCHIE, MATHEW ROBERT
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:ROBERT
Last Name:RITCHIE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 S 39TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-3331
Mailing Address - Country:US
Mailing Address - Phone:925-664-1416
Mailing Address - Fax:
Practice Address - Street 1:291 SMITH RANCH RD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2093
Practice Address - Country:US
Practice Address - Phone:415-492-0818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-03-17
Deactivation Date:2025-02-07
Deactivation Code:
Reactivation Date:2025-03-17
Provider Licenses
StateLicense IDTaxonomies
CAR1587081124101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)