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General NPI Number Information
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NPI Number | 1740689611
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Entity Type | Individual
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Provider Name | MEGHAN MATTOS PSYD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2014
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 9225 UNIVERSITY BLVD SUITE E2-A
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9149
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Country | US
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Telephone | 843-637-4211
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Fax |
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Provider Business Mailing Address
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Address Line | 9225 UNIVERSITY BLVD SUITE E2-A
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9149
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Country | US
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Telephone |
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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 | 0810004993
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1347
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License Number State | SC
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