Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1083998801 |
---|---|
Provider Name | Jill A Matusek |
First Address | Beachwood, OH 44122-5638 |
Second Address | Beachwood, OH 44122-5638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2011 |
Last Update Date | 29/09/2011 |