Provider Demographics
NPI:1700098464
Name:MORENO, MATTHEW PHILIP (AUD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PHILIP
Last Name:MORENO
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-3801
Mailing Address - Country:US
Mailing Address - Phone:508-829-5566
Mailing Address - Fax:
Practice Address - Street 1:695 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-3801
Practice Address - Country:US
Practice Address - Phone:508-829-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA793231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist