Provider Demographics
NPI:1932718996
Name:CAO, MATTHEW
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:CAO
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 1:3820 BEACON POINT ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8303
Mailing Address - Country:US
Mailing Address - Phone:702-722-7641
Mailing Address - Fax:
Practice Address - Street 1:3820 BEACON POINT ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8303
Practice Address - Country:US
Practice Address - Phone:702-722-7641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2025-08-15
Deactivation Date:2025-07-11
Deactivation Code:
Reactivation Date:2025-08-15
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NV12400-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician