Provider Demographics
NPI:1366066367
Name:BEDNARSKI, MATTHEW STREPPONE (CADC II)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:STREPPONE
Last Name:BEDNARSKI
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3503
Mailing Address - Country:US
Mailing Address - Phone:209-748-2470
Mailing Address - Fax:
Practice Address - Street 1:12490 ALTA MESA RD
Practice Address - Street 2:
Practice Address - City:HERALD
Practice Address - State:CA
Practice Address - Zip Code:95638-8409
Practice Address - Country:US
Practice Address - Phone:209-748-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI34171121101YA0400X
CAA063421123101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)