Matthew Fava

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

47392 Issued in CA

Legal business name

MATTHEW FAVA

Practice address

404 W Pine St
Lodi, CA 95240-2048

Phone

(209) 769-9554

Fax

(209) 435-0894

NPI assigned

Mar 28, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew Joseph Fava III, PSY.D, MFT

Title

Doctor

Phone

(209) 769-9554

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333584000000",
    "number": "1821117284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 YOKUTS DR",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952400690",
            "telephone_number": "209-769-9554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 W PINE ST",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952402048",
            "telephone_number": "209-769-9554",
            "fax_number": "209-435-0894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW FAVA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2012-04-05",
        "status": "A",
        "authorized_official_last_name": "FAVA",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "209-769-9554",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "PSY.D, MFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CA",
            "license": "47392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vincent Micheal Martinez
• Tasnim Masood, NP
• Wasim Masood
• Matrix Rehabilitation, Inc.
• Mykenzie Lauren Mattheis, DO
• Matthew Kim DDS Inc
• Allen Mau, D.D.S.
• Amanda Ellen Mauch, LE
• Abelardo Verceles Mayo, MD
• Mays Chiropractic Corp

• Mental Health Clinic/Center (Including Community Mental Health Center) in Lodi, CA
• Providers in Lodi, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.

Verify at the official NPI Registry.