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General NPI Number Information
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NPI Number | 1700186210
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Entity Type | Individual
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Provider Name | MATTHEW RYAN D'URSO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/30/2010
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 13 JAMES ST THIRD FLOOR
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City | MORRISTOWN
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State | NJ
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Zip | 07960-5941
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Country | US
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Telephone | 973-224-5983
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Fax | 973-829-6804
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Provider Business Mailing Address
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Address Line | 13 JAMES ST 3RD FLOOR
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City | MORRISTOWN
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State | NJ
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Zip | 07960-5941
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Country | US
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Telephone | 973-224-5983
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Fax | 973-655-5296
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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 | 35SI00504800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 019547-1
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License Number State | NY
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