Active NPI
Susan E Demattos
- Psychologist
- Renton, WA
National Provider Identifier
1396789236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY00002338
- Practice address
- 4445 Talbot Rd S
Renton, WA 98055-6219 - Phone
- (425) 656-4055
- Fax
- (425) 656-5425
- NPI assigned
- Jun 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY00002338 | WA | Primary |
Addresses
Primary practice location
4445 Talbot Rd S
Renton, WA 98055-6219
Mailing address
4445 Talbot Rd S
Renton, WA 98055-6219
Phone (425) 656-4055
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY00002338 | WA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Public Hospital District 1 of King County | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Prescription Pad Pharmacy South
- Institutional Pharmacy
- Renton, WA
- NPI 1679862189
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1396789236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4445 TALBOT RD S",
"city": "RENTON",
"state": "WA",
"postal_code": "980556219",
"telephone_number": "425-656-4055",
"fax_number": "425-656-5425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4445 TALBOT RD S",
"city": "RENTON",
"state": "WA",
"postal_code": "980556219",
"telephone_number": "425-656-4055",
"fax_number": "425-656-5425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMATTOS",
"first_name": "SUSAN",
"middle_name": "E",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-14",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WA",
"license": "PY00002338",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Renton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.