Provider Demographics
NPI:1285134478
Name:SPOTTEK, MATT KARL
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:KARL
Last Name:SPOTTEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 AHERN RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-6520
Mailing Address - Country:US
Mailing Address - Phone:607-760-2347
Mailing Address - Fax:
Practice Address - Street 1:35 FRONT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4703
Practice Address - Country:US
Practice Address - Phone:607-722-9190
Practice Address - Fax:607-722-6245
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004206101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health