Provider Demographics
NPI:1376169201
Name:DEMATTIA, MATTHEW (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DEMATTIA
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-3224
Mailing Address - Country:US
Mailing Address - Phone:631-905-9983
Mailing Address - Fax:
Practice Address - Street 1:1436 13TH ST
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-3224
Practice Address - Country:US
Practice Address - Phone:631-422-0869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023643-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist