Provider Demographics
NPI:1336397751
Name:BITSKO, MATT (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:
Last Name:BITSKO
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 1:1101 EAST MARSHALL STREET
Mailing Address - Street 2:SANGER HALL, 12-020
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-6455
Mailing Address - Country:US
Mailing Address - Phone:804-828-9048
Mailing Address - Fax:804-828-0504
Practice Address - Street 1:1101 EAST MARSHALL STREET
Practice Address - Street 2:SANGER HALL, 12-020
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-6455
Practice Address - Country:US
Practice Address - Phone:804-828-9048
Practice Address - Fax:804-828-0504
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003711103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist