1962888008 NPI number — MRS. RACHEL COURTNEY MATYJA LCPC

Table of content: MRS. RACHEL COURTNEY MATYJA LCPC (NPI 1962888008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962888008 NPI number — MRS. RACHEL COURTNEY MATYJA LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATYJA
Provider First Name:
RACHEL
Provider Middle Name:
COURTNEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANDFINGER
Provider Other First Name:
RACHEL
Provider Other Middle Name:
COURTNEY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962888008
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 WEST RD STE 112
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204-2358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
410-828-0300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 WEST RD STE 112
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-2358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-927-6535
Provider Business Practice Location Address Fax Number:
410-828-0300
Provider Enumeration Date:
07/30/2015

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: 101YP2500X , with the licence number:  LC6058 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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