Healthcare Provider Details

I. General information

NPI: 1043037690
Provider Name (Legal Business Name): KATHRYN MATULIEWICH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 W LANCASTER AVE STE 215
DEVON PA
19333-1585
US

IV. Provider business mailing address

237 W LANCASTER AVE STE 215
DEVON PA
19333-1585
US

V. Phone/Fax

Practice location:
  • Phone: 610-267-2468
  • Fax:
Mailing address:
  • Phone: 610-267-2468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP030660
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: