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General NPI Number Information
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NPI Number | 1619560067
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Entity Type | Individual
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Provider Name | MATTHEW JOSEPH FEDOR LSW
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Gender | Male
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Dates
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Enumeration Date | 02/17/2021
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 392 N MAIN ST
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City | ARCHBALD
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State | PA
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Zip | 18403-1820
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Country | US
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Telephone | 570-904-7363
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Fax | 570-348-4079
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Provider Business Mailing Address
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Address Line | 228 S MAIN AVE
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City | SCRANTON
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State | PA
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Zip | 18504-2545
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Country | US
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Telephone | 570-904-7363
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Fax | 570-348-4079
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW137836
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License Number State | PA
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