Provider Demographics
NPI:1922287101
Name:SKINTA, MATTHEW DAMON (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAMON
Last Name:SKINTA
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 1:563 CASTRO STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2511
Mailing Address - Country:US
Mailing Address - Phone:415-871-0882
Mailing Address - Fax:415-573-3190
Practice Address - Street 1:563 CASTRO STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2511
Practice Address - Country:US
Practice Address - Phone:415-871-0882
Practice Address - Fax:415-573-3190
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 103TH0004X
CA22822103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth