Provider Demographics
NPI:1386266658
Name:MATTHEW J DORTONA PSYD, PLLC
Entity type:Organization
Organization Name:MATTHEW J DORTONA PSYD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:D'ORTONA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:607-738-8887
Mailing Address - Street 1:100 N MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2901
Mailing Address - Country:US
Mailing Address - Phone:607-738-8887
Mailing Address - Fax:855-209-5530
Practice Address - Street 1:100 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2901
Practice Address - Country:US
Practice Address - Phone:607-738-8887
Practice Address - Fax:855-209-5530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-10
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health