Individual
DR. MATTHEW WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
870 EMERALD BAY RD # 303, BOX #3, SOUTH LAKE TAHOE, CA 96150-9403
(415) 806-0275
Mailing address
870 EMERALD BAY RD # 303, BOX #3, SOUTH LAKE TAHOE, CA 96150-9403
(415) 806-0275
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
26365
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/06/2009
Last updated
11/11/2016
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