Healthcare Provider Details

I. General information

NPI: 1922287101
Provider Name (Legal Business Name): MATTHEW DAMON SKINTA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 CASTRO STREET
SAN FRANCISCO CA
94114-2511
US

IV. Provider business mailing address

563 CASTRO STREET
SAN FRANCISCO CA
94114-2511
US

V. Phone/Fax

Practice location:
  • Phone: 415-871-0882
  • Fax: 415-573-3190
Mailing address:
  • Phone: 415-871-0882
  • Fax: 415-573-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number22822
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: