MEDICARE: DR. LISA MATTHEWS PSY.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	18894	CA

General Provider Information

NPI Number	:	1922743418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MATTHEWS PSY.D.

Provider Business Mailing Address
First Line	:	4317 E 14TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3010
Country	:	US
Telephone Number	:	562-719-3274
Fax Number	:

Provider Business Practice Location Address
First Line	:	4317 E 14TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3010
Country	:	US
Telephone Number	:	562-719-3274
Fax Number	:

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

Provider Enumeration Date	:	04/29/2022
Last Update Date	:	04/29/2022

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