Provider Demographics
NPI:1215480231
Name:MATTHEW A PORTADIN, PSY.D., LLC
Entity type:Organization
Organization Name:MATTHEW A PORTADIN, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PORTADIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:856-701-5586
Mailing Address - Street 1:91 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2247
Mailing Address - Country:US
Mailing Address - Phone:856-701-5586
Mailing Address - Fax:508-203-4718
Practice Address - Street 1:21 COCASSET ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2996
Practice Address - Country:US
Practice Address - Phone:856-701-5586
Practice Address - Fax:508-203-4718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9099103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty