Provider Demographics
NPI:1699870725
Name:SPALDING, MATTHEW L (EDM)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:L
Last Name:SPALDING
Suffix:
Gender:M
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3511
Mailing Address - Country:US
Mailing Address - Phone:415-404-6412
Mailing Address - Fax:
Practice Address - Street 1:161 MITCHELL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2068
Practice Address - Country:US
Practice Address - Phone:415-499-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health