Healthcare Provider Details

I. General information

NPI: 1013762947
Provider Name (Legal Business Name): LAUREN ELIZABETH MATEYKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 CENTER STREET
BETHLEHEM PA
18018
US

IV. Provider business mailing address

539 CENTER STREET
BETHLEHEM PA
18018
US

V. Phone/Fax

Practice location:
  • Phone: 484-896-9161
  • Fax: 484-251-5150
Mailing address:
  • Phone: 484-896-9161
  • Fax: 484-251-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: