Provider Demographics
NPI:1043223613
Name:DENIS, MATTHEW ERIC (PHD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ERIC
Last Name:DENIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 S ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-8362
Mailing Address - Country:US
Mailing Address - Phone:618-457-4488
Mailing Address - Fax:618-457-8844
Practice Address - Street 1:3412 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62903-8362
Practice Address - Country:US
Practice Address - Phone:618-457-4488
Practice Address - Fax:618-457-8844
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005515103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0003932032OtherBLUE CROSS BLUE SHIELD
045146OtherHEALTH ALLIANCE
229753000OtherMAGELLAN
UNSPECIFIEDOtherGREAT-WEST HEALTHCARE
2234448OtherFIRST HEALTH
429954OtherHEALTHLINK
UNSPECIFIEDOtherTRICARE
7184111OtherAETNA
IL210360Medicare UPIN