Provider Demographics
NPI:1528785532
Name:FITZGERALD-MATSON, VAL SIOBHAN
Entity type:Individual
Prefix:
First Name:VAL SIOBHAN
Middle Name:
Last Name:FITZGERALD-MATSON
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:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:PETERSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12138-0001
Mailing Address - Country:US
Mailing Address - Phone:716-517-5188
Mailing Address - Fax:
Practice Address - Street 1:660 JONES HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PETERSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12138-1213
Practice Address - Country:US
Practice Address - Phone:716-517-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health