Provider Demographics
NPI:1619035789
Name:CHIRMAN, MATTHEW ROBERT (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ROBERT
Last Name:CHIRMAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-1701
Mailing Address - Country:US
Mailing Address - Phone:805-543-5060
Mailing Address - Fax:888-364-3845
Practice Address - Street 1:1411 MARSH ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2967
Practice Address - Country:US
Practice Address - Phone:805-543-5060
Practice Address - Fax:888-364-3845
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39579106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist