Healthcare Provider Details

I. General information

NPI: 1992782379
Provider Name (Legal Business Name): ALICIA ANNE MATTESON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ALICIA ANN VALLENI MA

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TUSKEGEE BLVD
DOVER AFB DE
19902-5300
US

IV. Provider business mailing address

62 E DARBY CIR
DOVER DE
19904-6000
US

V. Phone/Fax

Practice location:
  • Phone: 302-677-2674
  • Fax:
Mailing address:
  • Phone: 302-698-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: