Provider Demographics
NPI:1205821790
Name:MATSAKIS, APHRODITE
Entity Type:Individual
Prefix:
First Name:APHRODITE
Middle Name:
Last Name:MATSAKIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10863 BUCKNELL DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4325
Mailing Address - Country:US
Mailing Address - Phone:301-649-3069
Mailing Address - Fax:
Practice Address - Street 1:10863 BUCKNELL DR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-4325
Practice Address - Country:US
Practice Address - Phone:301-649-3069
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00918103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD606853Medicare ID - Type Unspecified