MEDICARE: SAMANTHA MATHEWS COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1205633666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMANTHA MATHEWS COUNSELING

Provider Business Mailing Address
First Line	:	3714 MIDVALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1715
Country	:	US
Telephone Number	:	215-995-0061
Fax Number	:

Provider Business Practice Location Address
First Line	:	3714 MIDVALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1715
Country	:	US
Telephone Number	:	215-995-0061
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. SAMANTHA MATHEWS
Credential	:	LPC
Telephone Number	:	571-213-5155

Provider Enumeration Date	:	02/25/2025
Last Update Date	:	02/25/2025

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