Provider Demographics
NPI:1407326770
Name:BESSETTE, MATTHEW DEERING (MA, MT-BC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DEERING
Last Name:BESSETTE
Suffix:
Gender:M
Credentials:MA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3178 HILTON RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1059
Mailing Address - Country:US
Mailing Address - Phone:248-331-2744
Mailing Address - Fax:
Practice Address - Street 1:3178 HILTON RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1059
Practice Address - Country:US
Practice Address - Phone:248-331-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13230225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist