Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YS0200X | School Counselor | ||
N | 103K00000X | Behavior Analyst | ||
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TA0700X | Adult Development & Aging Psychologist | ||
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TE1100X | Exercise & Sports Psychologist | ||
N | 103TF0000X | Family Psychologist | ||
N | 103TF0200X | Forensic Psychologist | ||
N | 103TM1800X | Intellectual & Developmental Disabilities | ||
N | 103TP2701X | Group Psychotherapist |
NPI | 1134691322 |
---|---|
Provider Name | Dr. Jeanne Elizabeth Rota Matthews |
First Address | Bryn Mawr, PA 19010-3003 |
Second Address | Bryn Mawr, PA 19010-3003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2018 |
Last Update Date | 28/12/2018 |