Individual
MR. MATTHEW G FORTINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8960 COLONIAL CENTER DR STE 300, FORT MYERS, FL 33905-7810
(239) 343-3831
(239) 343-9498
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-9470
(239) 343-9498
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
Primary
PY12541
FL
103TC0700X
Clinical Psychologist
PY12541
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
931026892
UNITED HEALTHCARE
NY
Enumeration date
10/19/2016
Last updated
02/28/2025
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