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General NPI Number Information
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NPI Number | 1730462060
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Entity Type | Individual
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Provider Name | BEN F MCMATH III PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 902 MAIN AVE STE G
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City | NORTHPORT
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State | AL
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Zip | 35476-4434
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Country | US
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Telephone | 205-310-4497
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Fax |
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Provider Business Mailing Address
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Address Line | 10980 MEADOWS CIR
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City | VANCE
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State | AL
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Zip | 35490
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Country | US
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Telephone | 205-310-4497
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1489
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License Number State | AL
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