MEDICARE: DR. BEVERLY J MATTHEWS PSYD

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	103T00000X	Psychologist		IL

General Provider Information

NPI Number	:	1558463760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEVERLY J MATTHEWS PSYD

Provider Business Mailing Address
First Line	:	PO BOX 2416
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62524-2416
Country	:	US
Telephone Number	:	217-825-9010
Fax Number	:

Provider Business Practice Location Address
First Line	:	3517 CARNOUSTIE DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62712
Country	:	US
Telephone Number	:	217-529-4851
Fax Number	:

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/08/2007

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