Healthcare Provider Details

I. General information

NPI: 1497641179
Provider Name (Legal Business Name): MICHAEL F MATT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 ANTELOPE RD
CITRUS HEIGHTS CA
95610-2311
US

IV. Provider business mailing address

8556 PERSHING AVE
FAIR OAKS CA
95628-2939
US

V. Phone/Fax

Practice location:
  • Phone: 317-442-8286
  • Fax:
Mailing address:
  • Phone: 317-442-8286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW136137
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW136137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: