Provider Demographics
NPI:1679926786
Name:MATTHEWS, ALEXANDRA (PHD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MILLER AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2851
Mailing Address - Country:US
Mailing Address - Phone:415-388-0800
Mailing Address - Fax:
Practice Address - Street 1:275 MILLER AVE STE 203
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2851
Practice Address - Country:US
Practice Address - Phone:415-388-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16219103G00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist