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General NPI Number Information
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NPI Number | 1649401977
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Entity Type | Individual
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Provider Name | MR. MATTHEW THOMAS STILLEY
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Gender | Male
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 05/19/2016
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Provider Practice Location Address
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Address Line | 1930 MARLTON PIKE E BLDG T
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City | CHERRY HILL
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State | NJ
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Zip | 08003-2150
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Country | US
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Telephone | 609-458-3028
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Fax |
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Provider Business Mailing Address
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Address Line | 9510 AMHERST AVE APT 102
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City | MARGATE CITY
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State | NJ
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Zip | 08402-1074
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Country | US
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Telephone | 609-458-3028
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00201300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SL05915100
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License Number State | NJ
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