Healthcare Provider Details

I. General information

NPI: 1174757678
Provider Name (Legal Business Name): ALICJA MATUSIAK LISW-S, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICJA GRIFFITH

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 INDIANOLA AVE STE 107
COLUMBUS OH
43214-1862
US

IV. Provider business mailing address

4770 INDIANOLA AVE STE 107
COLUMBUS OH
43214-1862
US

V. Phone/Fax

Practice location:
  • Phone: 614-371-2303
  • Fax: 800-905-9950
Mailing address:
  • Phone: 614-371-2303
  • Fax: 800-905-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0800345
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number359101
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA.16032-NP
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.16032
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: