Individual
MR. MATTHEW BROAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCAT
Contact information
Practice address
1 MUSTARD ST STE 240250, ROCHESTER, NY 14609-6980
(585) 451-0028
(585) 654-1718
Mailing address
227 S UNION ST, SPENCERPORT, NY 14559-1403
(585) 451-0028
(585) 654-1718
Taxonomy
Speciality
Code
Description
License number
State
221700000X
Art Therapist
Primary
001375
NY
Other
Enumeration date
10/09/2020
Last updated
10/09/2020
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