Provider Demographics
NPI:1023381159
Name:MATTHEWS, JOSHUA ROBERT (MA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ROBERT
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4033
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92661-4033
Mailing Address - Country:US
Mailing Address - Phone:949-735-5809
Mailing Address - Fax:
Practice Address - Street 1:728 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1621
Practice Address - Country:US
Practice Address - Phone:949-735-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50965106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist