Provider Demographics
NPI:1215773627
Name:MATTHEW, EMILY A
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:MATTHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-1554
Mailing Address - Country:US
Mailing Address - Phone:202-517-3154
Mailing Address - Fax:
Practice Address - Street 1:1605 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1215
Practice Address - Country:US
Practice Address - Phone:510-923-1099
Practice Address - Fax:510-350-8793
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030469363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health