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General NPI Number Information
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NPI Number | 1295949717
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Entity Type | Individual
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Provider Name | MATTHEW L. WISE PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7330 WOODMONT AVE
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City | BETHESDA
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State | MD
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Zip | 20814-5354
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Country | US
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Telephone | 301-652-3880
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Fax |
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Provider Business Mailing Address
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Address Line | 8003 WHITTIER BLVD
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City | BETHESDA
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State | MD
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Zip | 20817-3120
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Country | US
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Telephone | 301-652-3880
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 04448
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License Number State | MD
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