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General NPI Number Information
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NPI Number | 1073884938
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Entity Type | Individual
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Provider Name | JENNIFER KANE MATASICK PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2012
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 1555 CONNECTICUT AVE NW SUITE 500
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City | WASHINGTON
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State | DC
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Zip | 20036-1111
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Country | US
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Telephone | 202-234-0903
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Fax |
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Provider Business Mailing Address
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Address Line | 241 17TH ST SE
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City | WASHINGTON
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State | DC
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Zip | 20003-1641
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Country | US
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Telephone | 978-430-5307
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY1000755
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License Number State | DC
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