Provider Demographics
NPI:1619303419
Name:DEMATTEI, MATTHEW (M ED)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:DEMATTEI
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5130
Mailing Address - Country:US
Mailing Address - Phone:602-347-4159
Mailing Address - Fax:
Practice Address - Street 1:801 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5130
Practice Address - Country:US
Practice Address - Phone:602-347-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4338187251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)