Healthcare Provider Details

I. General information

NPI: 1245767284
Provider Name (Legal Business Name): JENNA PAULINE MATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 FREEPORT RD STE 250
PITTSBURGH PA
15238-3121
US

IV. Provider business mailing address

4949 ELLSWORTH AVE
PITTSBURGH PA
15213-2806
US

V. Phone/Fax

Practice location:
  • Phone: 412-967-0610
  • Fax:
Mailing address:
  • Phone: 412-389-8489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS018924
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: