Provider Demographics
NPI:1598950065
Name:MATHEWS, JAMES B (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:MATHEWS
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 1:3 NORTHCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1207
Mailing Address - Country:US
Mailing Address - Phone:860-243-0565
Mailing Address - Fax:
Practice Address - Street 1:3 NORTHCLIFF DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-1207
Practice Address - Country:US
Practice Address - Phone:860-243-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000410103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist