Provider Demographics
NPI:1275958399
Name:MATTHEWS PSYCHOLOGICAL AND FAMILY SERVICES, PLLC
Entity Type:Organization
Organization Name:MATTHEWS PSYCHOLOGICAL AND FAMILY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:STEPHEN BURGESS
Authorized Official - Last Name:LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-776-5584
Mailing Address - Street 1:1811 SARDIS ROAD NORTH
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270
Mailing Address - Country:US
Mailing Address - Phone:704-776-5584
Mailing Address - Fax:704-845-6111
Practice Address - Street 1:1811 SARDIS ROAD NORTH
Practice Address - Street 2:SUITE 207
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270
Practice Address - Country:US
Practice Address - Phone:704-776-5584
Practice Address - Fax:704-845-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3953103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1730397191OtherTYPE 1 NPI FOR OWNER, DR. MATTHEW BURGESS LEARY, PH.D.