Healthcare Provider Details

I. General information

NPI: 1124637749
Provider Name (Legal Business Name): JAMIE MATTHEWS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ROUTE 70 E BLDG A100
MARLTON NJ
08053-2341
US

IV. Provider business mailing address

765 ROUTE 70 E BLDG A100
MARLTON NJ
08053-2341
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-3900
  • Fax: 856-797-4785
Mailing address:
  • Phone: 856-983-3900
  • Fax: 856-797-4785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00706500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: