Healthcare Provider Details

I. General information

NPI: 1033997820
Provider Name (Legal Business Name): TAYLOR MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 SOUTH ST FL 2
WALTHAM MA
02453-1422
US

IV. Provider business mailing address

746 SOUTH ST
WALTHAM MA
02453-1422
US

V. Phone/Fax

Practice location:
  • Phone: 617-278-5300
  • Fax:
Mailing address:
  • Phone: 617-278-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: