Provider Demographics
NPI:1518017177
Name:STEVENS, MATTHEW D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:STEVENS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 UPPER BEVERLY HLS
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2105
Mailing Address - Country:US
Mailing Address - Phone:413-262-1645
Mailing Address - Fax:
Practice Address - Street 1:576 STATE STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-1234
Practice Address - Country:US
Practice Address - Phone:413-781-6485
Practice Address - Fax:413-788-6925
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10783103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical