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General NPI Number Information
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NPI Number | 1043712862
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Entity Type | Individual
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Provider Name | MATTHEW DIETZ PMHNP-BC, RN
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Gender | Male
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 3690 ORANGE PL STE 320
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City | BEACHWOOD
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State | OH
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Zip | 44122-4432
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Country | US
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Telephone | 216-831-1494
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Fax | 216-831-9931
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Provider Business Mailing Address
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Address Line | 3690 ORANGE PL STE 320
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City | BEACHWOOD
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State | OH
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Zip | 44122-4432
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Country | US
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Telephone | 216-831-1494
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Fax | 216-831-9931
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 854944
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN394717
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP143192
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License Number State | TX
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