Provider Demographics
NPI:1770294217
Name:DEMATTEIS, RENEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:DEMATTEIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 CENTRAL AVE STE 1230
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3865
Mailing Address - Country:US
Mailing Address - Phone:814-460-3190
Mailing Address - Fax:
Practice Address - Street 1:360 CENTRAL AVE STE 1230
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3865
Practice Address - Country:US
Practice Address - Phone:727-249-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019772103TC0700X
FLPSY11946103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical