Individual
MS. KELLY MARIE MATELJAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
131 MARKET ST, JOHNSTOWN, PA 15901-1628
(814) 534-0745
(814) 536-5431
Mailing address
613 MAIN ST, GALLITZIN, PA 16641-1427
(814) 534-0745
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW015170
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215902762
NPIN
—
01
—
MA 1446205
BC/ BS NETWORK PROVIDER #
PA
Enumeration date
02/20/2006
Last updated
07/09/2007
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