1952462095 NPI number — MR. MATTHEW VERGHESE LCSW, MFT

Table of content: LUTHER BURSE JR. M.D. (NPI 1366441438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952462095 NPI number — MR. MATTHEW VERGHESE LCSW, MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERGHESE
Provider First Name:
MATTHEW
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, MFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952462095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
727 WELSH ROAD SUITE 202
Provider Second Line Business Mailing Address:
PHILMONT GUIDANCE CENTER
Provider Business Mailing Address City Name:
HUNTINGDON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-914-2119
Provider Business Mailing Address Fax Number:
215-914-1663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
727 WELSH ROAD SUITE 202
Provider Second Line Business Practice Location Address:
PHILMONT GUIDANCE CENTER
Provider Business Practice Location Address City Name:
HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-914-2119
Provider Business Practice Location Address Fax Number:
215-914-1663
Provider Enumeration Date:
12/13/2006

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: 1041C0700X , with the licence number:  CW013758 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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