Organization
MICHELE MATTIE, PHD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELE MATTIE PHD (OWNER)
(570) 718-1150
Entity
Organization
Contact information
Practice address
517 PIERCE ST, SUITE B, KINGSTON, PA 18704-5731
(570) 718-1150
(570) 714-1321
Mailing address
517 PIERCE ST, SUITE B, KINGSTON, PA 18704-5731
(570) 718-1150
(570) 714-1321
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PS008609L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285665075
INDIVIDUAL NPI
PA
01
—
359151
BLUE SHIELD
PA
Enumeration date
09/01/2006
Last updated
08/22/2020
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