Provider Demographics
NPI:1922368844
Name:RASO, MATTHEW AMORE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:AMORE
Last Name:RASO
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 1:50 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4224
Mailing Address - Country:US
Mailing Address - Phone:518-368-3462
Mailing Address - Fax:
Practice Address - Street 1:12 CENTURY HILL DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2123
Practice Address - Country:US
Practice Address - Phone:518-302-2812
Practice Address - Fax:518-309-6593
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019522-1103TS0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool