Healthcare Provider Details

I. General information

NPI: 1821466004
Provider Name (Legal Business Name): MATTHEW READ CORNISH LADC I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 MAIN ST
TAUNTON MA
02780-2777
US

IV. Provider business mailing address

10223 AVALON DR
WEYMOUTH MA
02188-4641
US

V. Phone/Fax

Practice location:
  • Phone: 508-880-1598
  • Fax:
Mailing address:
  • Phone: 617-595-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1665
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: