Healthcare Provider Details

I. General information

NPI: 1841480118
Provider Name (Legal Business Name): MATTHEW JACOB MEYER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N LA BREA AVE 5TH FLOOR
INGLEWOOD CA
90301-1752
US

IV. Provider business mailing address

1902 SHELL AVE
VENICE CA
90291-3879
US

V. Phone/Fax

Practice location:
  • Phone: 310-677-7808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY20600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: