Provider Demographics
NPI:1386256618
Name:WEDDLETON, MATTHEW JACOB
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JACOB
Last Name:WEDDLETON
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 1:150 MEDITERRANEAN DR APT 32
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-3839
Mailing Address - Country:US
Mailing Address - Phone:781-626-0366
Mailing Address - Fax:
Practice Address - Street 1:150 MEDITERRANEAN DR APT 32
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-3839
Practice Address - Country:US
Practice Address - Phone:781-626-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA888888993OtherTUFTS HEALTH PLAN