Provider Demographics
NPI:1477006914
Name:DESPARD, MATTHEW ERIC
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ERIC
Last Name:DESPARD
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 1:3 GORDON LN
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4707
Mailing Address - Country:US
Mailing Address - Phone:413-896-8431
Mailing Address - Fax:
Practice Address - Street 1:249 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1679
Practice Address - Country:US
Practice Address - Phone:413-896-8431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health