Provider Demographics
NPI:1972798981
Name:CELOZZI, II, MATTHEW JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:CELOZZI, II
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 1:7019 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2607
Mailing Address - Country:US
Mailing Address - Phone:410-298-3434
Mailing Address - Fax:
Practice Address - Street 1:1101 N CALVERT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3840
Practice Address - Country:US
Practice Address - Phone:410-298-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1279103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD016594800Medicaid
MDG097Medicare PIN