Healthcare Provider Details

I. General information

NPI: 1003911512
Provider Name (Legal Business Name): KIMBERLY MATHOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/25/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 SOUTH AVE
PITTSBURGH PA
15221-2940
US

IV. Provider business mailing address

1945 FIFTH AVENUE CENTER FOR HEARING AND DEAF SERVICES
PITTSBURGH PA
15219
US

V. Phone/Fax

Practice location:
  • Phone: 412-243-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS008024L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: