=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487500518
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARRA DEMATTEO BEHAVIORAL SPECIALIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2026
-----------------------------------------------------
Last Update Date | 03/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 416 S PITTSBURGH ST
-----------------------------------------------------
City | CONNELLSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15425-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-626-8420
-----------------------------------------------------
Fax | 724-628-0898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 416 S PITTSBURGH ST
-----------------------------------------------------
City | CONNELLSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15425-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-626-8420
-----------------------------------------------------
Fax | 724-628-0898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | BH007660
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------