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General NPI Number Information
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NPI Number | 1861811440
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Entity Type | Individual
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Provider Name | MATTHEW DIANTHONY PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 10/12/2024
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Provider Practice Location Address
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Address Line | 1055 E 2100 S STE 205
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-2579
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Country | US
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Telephone | 412-626-0897
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Fax |
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Provider Business Mailing Address
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Address Line | 2191 S MCCLELLAND ST APT 556
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-4455
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Country | US
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Telephone | 201-572-8610
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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 | PS019006
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License Number State | PA
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