MEDICARE: DR. MATT CAMPORESE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	60817307	WA
2	103TC0700X	Clinical Psychologist	022980	NY

General Provider Information

NPI Number	:	1912275835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATT CAMPORESE PH.D.

Provider Business Mailing Address
First Line	:	2817 ROCK MERRITT AVE
Second Line	:	STOP A
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-0001
Country	:	US
Telephone Number	:	910-907-8707
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ROCK MERRITT AVE
Second Line	:	STOP A
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-0001
Country	:	US
Telephone Number	:	910-907-8707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2011
Last Update Date	:	04/15/2026

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