Provider Demographics
NPI:1346707270
Name:GOLLEY, MATTHEW (PHD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:GOLLEY
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:SAMUEL S. STRATTON VAMC
Mailing Address - Street 2:113 HOLLAND AVENUE
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-626-5414
Mailing Address - Fax:
Practice Address - Street 1:SAMUEL S. STRATTON VAMC
Practice Address - Street 2:113 HOLLAND AVENUE
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-626-5414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023139103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical