Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 7723 | MA |
NPI | 1942448204 |
---|---|
Provider Name | Mr. Matthew David Dong |
First Address | Somerville, MA 02144-1210 |
Second Address | Belmont, MA 02478-4901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2009 |
Last Update Date | 25/01/2009 |