Provider Demographics
NPI:1629217302
Name:MATTHEWS, AMY DONOVAN (MS, MED)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DONOVAN
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 GOLD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2649
Mailing Address - Country:US
Mailing Address - Phone:617-596-2350
Mailing Address - Fax:
Practice Address - Street 1:174 DORCHESTER ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2844
Practice Address - Country:US
Practice Address - Phone:617-596-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000006935101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health