Provider Demographics
NPI:1700186210
Name:D'URSO, MATTHEW RYAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RYAN
Last Name:D'URSO
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 1:13 JAMES ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5941
Mailing Address - Country:US
Mailing Address - Phone:973-224-5983
Mailing Address - Fax:973-655-5296
Practice Address - Street 1:13 JAMES ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5941
Practice Address - Country:US
Practice Address - Phone:973-224-5983
Practice Address - Fax:973-829-6804
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-30
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00504800103T00000X
NY019547-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist