Provider Demographics
NPI:1881739233
Name:SNOW, MATTHEW GORDON (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GORDON
Last Name:SNOW
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WEST MAIN STREET
Mailing Address - Street 2:SUITE 410
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702
Mailing Address - Country:US
Mailing Address - Phone:203-805-6408
Mailing Address - Fax:203-805-6432
Practice Address - Street 1:55 WEST MAIN STREET
Practice Address - Street 2:SUITE 410
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702
Practice Address - Country:US
Practice Address - Phone:203-805-6408
Practice Address - Fax:203-805-6432
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT001830103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist