Provider Demographics
NPI:1063706315
Name:MATT SHOLLENBERGER, PHD PC
Entity type:Organization
Organization Name:MATT SHOLLENBERGER, PHD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOLLENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:484-459-6423
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 NORTH PARK ROAD SUITE 204
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610
Practice Address - Country:US
Practice Address - Phone:484-459-6423
Practice Address - Fax:484-388-4359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002868101YP2500X, 103TB0200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2750535OtherHIGHMARK BLUE SHIELD
PA592454000OtherKEYSTONE
PA2319238000OtherIBC
PA2290709OtherCIGNA
PA50102905OtherCAPITAL BLUE CROSS
PA7784522OtherAETNA