Provider Demographics
NPI:1902844277
Name:MATTER, COLLEEN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:A
Last Name:MATTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 WESTFALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4645
Mailing Address - Country:US
Mailing Address - Phone:585-463-2668
Mailing Address - Fax:585-463-2669
Practice Address - Street 1:465 WESTFALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4645
Practice Address - Country:US
Practice Address - Phone:585-463-2668
Practice Address - Fax:585-463-2669
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015080-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical