Provider Demographics
NPI:1841865433
Name:CAMMARANO, MATTHEW S
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:CAMMARANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29353 HIDDEN OAK PL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-5907
Mailing Address - Country:US
Mailing Address - Phone:818-795-8015
Mailing Address - Fax:
Practice Address - Street 1:29353 HIDDEN OAK PL
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91387-5907
Practice Address - Country:US
Practice Address - Phone:818-795-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician