Provider Demographics
NPI:1790103372
Name:LONGORIA, MATTHEW (CADC-II, CDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LONGORIA
Suffix:
Gender:M
Credentials:CADC-II, CDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6956 BERTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4708
Mailing Address - Country:US
Mailing Address - Phone:818-654-4907
Mailing Address - Fax:818-514-2900
Practice Address - Street 1:6956 BERTRAND AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4708
Practice Address - Country:US
Practice Address - Phone:818-654-4907
Practice Address - Fax:818-514-2900
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)