Provider Demographics
NPI:1073284667
Name:YANOVSKIY, MATTHEW STANLEY (APRN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:STANLEY
Last Name:YANOVSKIY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CAREMATRIX DR
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6149
Mailing Address - Country:US
Mailing Address - Phone:781-647-6587
Mailing Address - Fax:
Practice Address - Street 1:10 CAREMATRIX DR
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6149
Practice Address - Country:US
Practice Address - Phone:781-647-6587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2340274363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health