Healthcare Provider Details

I. General information

NPI: 1255312716
Provider Name (Legal Business Name): MATTHEW TODD BELL PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC; ATTN: CREDENTIALS 11505 MT BELEVEDERE BLVD
FT. DRUM NY
13602-5004
US

IV. Provider business mailing address

USA MEDDAC; ATTN: CREDENTIALS 11505 MT BELEVEDERE BLVD
FT. DRUM NY
13602-5004
US

V. Phone/Fax

Practice location:
  • Phone: 315-772-4025
  • Fax: 315-772-9498
Mailing address:
  • Phone: 315-772-4025
  • Fax: 315-772-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1280
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: