MEDICARE: MATTHEW GEORGE MARKON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW016386	PA

General Provider Information

NPI Number	:	1467685032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW GEORGE MARKON LCSW

Provider Business Mailing Address
First Line	:	401 SHADY AVE
Second Line	:	SUITE D-106
City	:	PITTSBURGH
State	:	PA
Zip	:	15206-4409
Country	:	US
Telephone Number	:	412-689-3255
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 SHADY AVE STE D106
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15206-4460
Country	:	US
Telephone Number	:	412-689-3255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	10/20/2018

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