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General NPI Number Information
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NPI Number | 1023756392
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Entity Type | Individual
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Provider Name | MELISSA MATAMOROS B.A
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Gender | Female
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Dates
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Enumeration Date | 05/25/2022
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 145 N EAGLE RD
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City | HAVERTOWN
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State | PA
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Zip | 19083-3418
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Country | US
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Telephone | 610-446-1861
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Fax |
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Provider Business Mailing Address
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Address Line | 3226 BIRCH HILL DR
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City | TANNERSVILLE
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State | PA
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Zip | 18372-7836
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Country | US
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Telephone | 570-688-5321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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