Provider Demographics
NPI:1639669237
Name:ZAITCHIK, MATT (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:
Last Name:ZAITCHIK
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 1:102C PALMER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-7741
Mailing Address - Country:US
Mailing Address - Phone:401-254-5333
Mailing Address - Fax:
Practice Address - Street 1:102C PALMER DR
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-7741
Practice Address - Country:US
Practice Address - Phone:401-254-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4714-PY-PR103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty