Provider Demographics
NPI:1114588225
Name:IRENE MATIATOS, PHD, INC.
Entity Type:Organization
Organization Name:IRENE MATIATOS, PHD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIATOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:551-206-3762
Mailing Address - Street 1:23 SILVER DARTER LN
Mailing Address - Street 2:
Mailing Address - City:BILTMORE LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28715-9526
Mailing Address - Country:US
Mailing Address - Phone:551-206-3762
Mailing Address - Fax:
Practice Address - Street 1:23 SILVER DARTER LN
Practice Address - Street 2:
Practice Address - City:BILTMORE LAKE
Practice Address - State:NC
Practice Address - Zip Code:28715-9526
Practice Address - Country:US
Practice Address - Phone:551-206-3762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty