Provider Demographics
NPI:1366881500
Name:PERCY, MATTHEW STUART (PSYD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:STUART
Last Name:PERCY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 NE RAVENNA BLVD
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6460
Mailing Address - Country:US
Mailing Address - Phone:206-527-2266
Mailing Address - Fax:
Practice Address - Street 1:564 NE RAVENNA BLVD
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6460
Practice Address - Country:US
Practice Address - Phone:206-527-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY532103TC0700X
WAPY60425207103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical