Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 9856 | MA |
Y | 103G00000X | Clinical Psychologist | 9856 | MA |
Y | 103TC0700X | Clinical Psychologist | 9856 | MA |
NPI | 1033534771 |
---|---|
Provider Name | Mr. Matthew Schrock |
First Address | Belmont, MA 02478-1064 |
Second Address | Belmont, MA 02478-1064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2014 |
Last Update Date | 12/03/2014 |