Provider Demographics
NPI:1437202074
Name:CIANFRANI, MATTHEW M (PHD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:CIANFRANI
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 1:3361 NE AVIARY PL
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4275
Mailing Address - Country:US
Mailing Address - Phone:772-208-0055
Mailing Address - Fax:
Practice Address - Street 1:3361 NE AVIARY PL
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4275
Practice Address - Country:US
Practice Address - Phone:772-208-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3865103T00000X
FLPY8709103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist