Provider Demographics
NPI:1861934242
Name:CARR, MATTHEW V G (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:V G
Last Name:CARR
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:MR
Other - First Name:MATTHEW
Other - Middle Name:V
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:106 BIMINI LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2000
Mailing Address - Country:US
Mailing Address - Phone:443-896-6170
Mailing Address - Fax:
Practice Address - Street 1:14409 GREENVIEW DR
Practice Address - Street 2:102
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3293
Practice Address - Country:US
Practice Address - Phone:301-498-8100
Practice Address - Fax:301-498-0009
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2202008935235Z00000X
MD07487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist