1063691756 NPI number — MS. AMANDA L MATLEE MSW LSW

Table of content: MS. AMANDA L MATLEE MSW LSW (NPI 1063691756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063691756 NPI number — MS. AMANDA L MATLEE MSW LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATLEE
Provider First Name:
AMANDA
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATOVSKY
Provider Other First Name:
AMANDA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063691756
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 PURSEL STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILLIPSBURG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08865-3435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-619-1601
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
492 ROUTE 57 WEST
Provider Second Line Business Practice Location Address:
FAMILY GUIDANCE CENTER OF WARREN COUNTY
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07882-1420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-689-1000
Provider Business Practice Location Address Fax Number:
908-689-4529
Provider Enumeration Date:
10/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  44SL05445600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)