Healthcare Provider Details

I. General information

NPI: 1114433588
Provider Name (Legal Business Name): MATTHEW B. NAUGHTON CPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 EL CAJON BLVD STE 13
SAN DIEGO CA
92104-1430
US

IV. Provider business mailing address

4541 HAMILTON ST APT 5
SAN DIEGO CA
92116-3033
US

V. Phone/Fax

Practice location:
  • Phone: 619-521-5720
  • Fax: 619-521-5728
Mailing address:
  • Phone: 619-613-6877
  • Fax: 619-795-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1544610124
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: