Provider Demographics
NPI:1023418597
Name:GLIDDEN, MATTHEW C (PSYD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
Last Name:GLIDDEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 UTICA AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3852
Mailing Address - Country:US
Mailing Address - Phone:909-989-4055
Mailing Address - Fax:
Practice Address - Street 1:8300 UTICA AVE STE 245
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3852
Practice Address - Country:US
Practice Address - Phone:909-989-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY31153103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program