Provider Demographics
NPI:1730283235
Name:MUTI, MATTEO RENATO (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTEO
Middle Name:RENATO
Last Name:MUTI
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 1:12214 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3830
Mailing Address - Country:US
Mailing Address - Phone:818-763-1212
Mailing Address - Fax:818-980-5222
Practice Address - Street 1:12214 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3830
Practice Address - Country:US
Practice Address - Phone:818-763-1212
Practice Address - Fax:818-980-5222
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA004454103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPL004454Medicare ID - Type UnspecifiedPSYCHOLOGY