Provider Demographics
NPI:1710055785
Name:WEISSKOPF, MATTHEW (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:WEISSKOPF
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5339 OUTLOOK PT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-1819
Mailing Address - Country:US
Mailing Address - Phone:858-232-6136
Mailing Address - Fax:888-753-7206
Practice Address - Street 1:2423 CAMINO DEL RIO S STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3734
Practice Address - Country:US
Practice Address - Phone:858-232-6136
Practice Address - Fax:888-753-7206
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21048103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY21048OtherPSYCHOLOGIST