Provider Demographics
NPI:1871259341
Name:MATTIMOE, SHELLEY MARIE
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:MARIE
Last Name:MATTIMOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:MARIE
Other - Last Name:REZAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:533A CASTRO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2511
Mailing Address - Country:US
Mailing Address - Phone:858-304-0364
Mailing Address - Fax:
Practice Address - Street 1:533A CASTRO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2511
Practice Address - Country:US
Practice Address - Phone:858-304-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist