Provider Demographics
NPI:1407991334
Name:VOLZER, MATTHEW CHARLES
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHARLES
Last Name:VOLZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 TRIMSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-8819
Mailing Address - Country:US
Mailing Address - Phone:916-672-7692
Mailing Address - Fax:
Practice Address - Street 1:5701 LONETREE BLVD
Practice Address - Street 2:123
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-3772
Practice Address - Country:US
Practice Address - Phone:916-672-7692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52979106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist