Provider Demographics
NPI:1114433588
Name:NAUGHTON, MATTHEW B (CPSS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:NAUGHTON
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 HAMILTON ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-3033
Mailing Address - Country:US
Mailing Address - Phone:619-613-6877
Mailing Address - Fax:619-795-6906
Practice Address - Street 1:3288 EL CAJON BLVD STE 13
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1430
Practice Address - Country:US
Practice Address - Phone:619-521-5720
Practice Address - Fax:619-521-5728
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175T00000X
CAR1544610124101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty