Active NPI
Traci S. Matterese, M.A. C.A.S.
- School Psychologist
- Latham, NY
National Provider Identifier
1447508262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- Practice address
- 623 New Loudon Road
Latham, NY 12110 - Phone
- (518) 782-1178
- Fax
- (518) 782-3334
- NPI assigned
- Aug 28, 2012
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | NY | Primary |
Addresses
Primary practice location
623 New Loudon Road
Latham, NY 12110
Mailing address
623 New Loudon Road
Latham, NY 12110
Phone (518) 782-1178
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)
- Not enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346112000000",
"number": "1447508262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "623 NEW LOUDON ROAD",
"city": "LATHAM",
"state": "NY",
"postal_code": "12110",
"telephone_number": "518-782-1178",
"fax_number": "518-782-3334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "623 NEW LOUDON ROAD",
"city": "LATHAM",
"state": "NY",
"postal_code": "12110",
"telephone_number": "518-782-1178",
"fax_number": "518-782-3334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTERESE",
"first_name": "TRACI",
"middle_name": "S.",
"name_prefix": "Mrs.",
"credential": "M.A. C.A.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-28",
"last_updated": "2012-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NY",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Latham, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.