Provider Demographics
NPI:1861811440
Name:DIANTHONY, MATTHEW (PSYD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:DIANTHONY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 S MCCLELLAND ST APT 556
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4455
Mailing Address - Country:US
Mailing Address - Phone:201-572-8610
Mailing Address - Fax:
Practice Address - Street 1:1055 E 2100 S STE 205
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2579
Practice Address - Country:US
Practice Address - Phone:412-626-0897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019006103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical