MEDICARE: MATTHEW ELLIOTT 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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1912842212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ELLIOTT PH.D.

Provider Business Mailing Address
First Line	:	611 VETERANS BLVD STE 200
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 VETERANS BLVD STE 200
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1401
Country	:	US
Telephone Number	:	650-539-6358
Fax Number	:

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

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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