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General NPI Number Information
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NPI Number | 1205711322
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Entity Type | Individual
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Provider Name | MATTHEW ROBERT RADICAN LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 201 S TYLER ST
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City | DALLAS
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State | TX
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Zip | 75208-4934
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Country | US
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Telephone | 214-942-5166
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Fax |
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Provider Business Mailing Address
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Address Line | 4539 FRIARS LN
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-3606
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Country | US
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Telephone | 951-757-9474
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Fax |
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 2426-2426A
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License Number State | TX
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