Provider Demographics
NPI:1063514875
Name:SHOLLENBERGER, MATT (PHD)
Entity type:Individual
Prefix:DR
First Name:MATT
Middle Name:
Last Name:SHOLLENBERGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 N PARK RD STE 204
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1341
Mailing Address - Country:US
Mailing Address - Phone:484-459-6423
Mailing Address - Fax:484-388-4359
Practice Address - Street 1:833 N PARK RD STE 204
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1341
Practice Address - Country:US
Practice Address - Phone:484-459-6423
Practice Address - Fax:484-388-4359
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002868101YP2500X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2319238000OtherIBC
PA7784522OtherAETNA
PA592454000OtherKEYSTONE