=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104051358
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS F. MATTA, PH.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2009
-----------------------------------------------------
Last Update Date | 05/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2730 HERSHEY RD
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16509-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-873-1911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2730 HERSHEY RD
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16509-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-873-1911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. THOMAS FRANCIS MATTA
-----------------------------------------------------
Credential | L.M.F.T.
-----------------------------------------------------
Telephone | 814-873-1911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MF000001
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------