Provider Demographics
NPI:1023212453
Name:CALKINS, MATTHEW GRANT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GRANT
Last Name:CALKINS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FREMONT AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3225
Mailing Address - Country:US
Mailing Address - Phone:213-595-5832
Mailing Address - Fax:
Practice Address - Street 1:1515 HOPE ST STE 202
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2610
Practice Address - Country:US
Practice Address - Phone:213-595-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21783103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical