Provider Demographics
NPI:1104265321
Name:MATERDO, EMILY JOYCE (LCSWA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JOYCE
Last Name:MATERDO
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 PINE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-9480
Mailing Address - Country:US
Mailing Address - Phone:704-517-2106
Mailing Address - Fax:
Practice Address - Street 1:406 PINE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-9480
Practice Address - Country:US
Practice Address - Phone:704-517-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0437133481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical