Provider Demographics
NPI:1215069349
Name:MATTHEWS, PATRICIA (EDS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 N NANCY ROSE BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3518
Mailing Address - Country:US
Mailing Address - Phone:520-795-2598
Mailing Address - Fax:
Practice Address - Street 1:750 N ROSEMONT BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1229
Practice Address - Country:US
Practice Address - Phone:520-232-8314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool