Provider Demographics
NPI:1760850051
Name:TAYLOR, MATTHEW A (PSYD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-1620
Mailing Address - Country:US
Mailing Address - Phone:304-626-5825
Mailing Address - Fax:
Practice Address - Street 1:400 RUSSELL DRIVE
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037
Practice Address - Country:US
Practice Address - Phone:504-678-4539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1512103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical