Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 010778-1 | NY |
N | 103G00000X | Clinical Psychologist | 010778-1 | NY |
N | 103TC0700X | Clinical Psychologist | 010778-1 | NY |
Y | 103G00000X | Clinical Psychologist | 3902 | NC |
Y | 103TC0700X | Clinical Psychologist | 3902 | NC |
N | 103TF0000X | Family Psychologist | 010778-1 | NY |
NPI | 1215000773 |
---|---|
Provider Name | Dr. Irene Matiatos |
First Address | Biltmore Lake, NC 28715-9526 |
Second Address | Biltmore Lake, NC 28715-9526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 23/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
386523 | MVP (01) | NY |
6802210 | GHI (01) | NY |
P570970 | OXFORD (01) | NY |
S10778 | WORKERS COMPENSATION (01) | NY |