Provider Demographics
NPI:1568191278
Name:CANCIO, MATTHEW STEPHAN
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:STEPHAN
Last Name:CANCIO
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 1:620 ELM AVE RM 240
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73019-3142
Mailing Address - Country:US
Mailing Address - Phone:405-325-2911
Mailing Address - Fax:
Practice Address - Street 1:620 ELM AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73019-3142
Practice Address - Country:US
Practice Address - Phone:405-325-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health