Provider Demographics
NPI:1013981505
Name:BAITY, MATTHEW RYAN (PHD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RYAN
Last Name:BAITY
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 1:2030 W EL CAMINO AVE
Mailing Address - Street 2:ALLIANT INTERNATIONAL UNIVERSITY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-1866
Mailing Address - Country:US
Mailing Address - Phone:510-274-8567
Mailing Address - Fax:
Practice Address - Street 1:2030 W EL CAMINO AVE
Practice Address - Street 2:ALLIANT INTERNATIONAL UNIVERSITY
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-1866
Practice Address - Country:US
Practice Address - Phone:510-274-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22917103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1854216Medicaid
MAW06340OtherBCBS MA
MA1854216Medicaid