Provider Demographics
NPI:1235467010
Name:SEWELL, MATTHEW TODD (PHD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:TODD
Last Name:SEWELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAN RAFAEL AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1116
Mailing Address - Country:US
Mailing Address - Phone:505-823-1600
Mailing Address - Fax:
Practice Address - Street 1:1 SAN RAFAEL AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-1116
Practice Address - Country:US
Practice Address - Phone:505-823-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-06
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1425103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical