Provider Demographics
NPI:1528102126
Name:KASNETZ, MATTHEW D (PHD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:KASNETZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 STILES RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2899
Mailing Address - Country:US
Mailing Address - Phone:603-893-7700
Mailing Address - Fax:603-893-7331
Practice Address - Street 1:87 STILES RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2899
Practice Address - Country:US
Practice Address - Phone:603-893-7700
Practice Address - Fax:603-893-7331
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH461103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0518956Medicaid
MAGELLAN BEHAVIORALOther83815000
NH8000 0601Medicaid
1036669OtherCIGNA BEHAVIORAL HEALTH
004547OtherTUFTS
MA0518956Medicaid