Provider Demographics
NPI:1275794869
Name:MATT MOORADIAN,PSY,D. P.C.
Entity Type:Organization
Organization Name:MATT MOORADIAN,PSY,D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-836-3101
Mailing Address - Street 1:9245 CALUMET AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9245 CALUMET AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2821
Practice Address - Country:US
Practice Address - Phone:219-836-3101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040803103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN203670Medicare PIN