Provider Demographics
NPI:1154603074
Name:DELGIUDICE, MATTHEW JACK (PSYD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JACK
Last Name:DELGIUDICE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 NORTHLAKE DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-1650
Mailing Address - Country:US
Mailing Address - Phone:513-258-1721
Mailing Address - Fax:
Practice Address - Street 1:11500 NORTHLAKE DR
Practice Address - Street 2:SUITE 230
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-1650
Practice Address - Country:US
Practice Address - Phone:513-258-1721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical