Healthcare Provider Details

I. General information

NPI: 1083998801
Provider Name (Legal Business Name): JILL A MATUSEK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25550 CHAGRIN BLVD 200
BEACHWOOD OH
44122-5638
US

IV. Provider business mailing address

25550 CHAGRIN BLVD 200
BEACHWOOD OH
44122-5638
US

V. Phone/Fax

Practice location:
  • Phone: 216-765-0500
  • Fax: 216-765-0521
Mailing address:
  • Phone: 216-765-0500
  • Fax: 216-765-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.7004
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: