Matthew Gibson Campbell, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

9479 Issued in NY

Practice address

22 Lawrence Ave Ste 304
Smithtown, NY 11787-3619

Phone

(631) 361-6858

Fax

(631) 224-4992

NPI assigned

Jun 22, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2013 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293062400000",
    "number": "1841496270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 WHITNEY GATE",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "11787",
            "telephone_number": "631-361-6858",
            "fax_number": "631-224-4992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 LAWRENCE AVE STE 304",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117873619",
            "telephone_number": "631-361-6858",
            "fax_number": "631-224-4992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "MATTHEW",
        "middle_name": "GIBSON",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-22",
        "last_updated": "2010-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "9479",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "9479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Rita Callahan, LCSW
• Marian V Callahan, L. AC
• Meryl A. Camer, LCSW
• Angela Rosaria Cammarata, LCSW-R
• Leona Wilhelmina Campbell Corbet, FNP
• Barbra Canale-Digiovanna, LCSW
• Abigail L Canaletich
• Lisa R. Cane, PH.D.
• Xinping Cao, L.AC.
• Gloria Capogna

• Clinical Psychologist in Smithtown, NY
• Providers in Smithtown, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.