Provider Demographics
NPI:1114037272
Name:MATTERN, ULRIKE (MA LPA)
Entity type:Individual
Prefix:MS
First Name:ULRIKE
Middle Name:
Last Name:MATTERN
Suffix:
Gender:F
Credentials:MA LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 STEVENS MILL RD
Mailing Address - Street 2:CHERRY HOSPITAL
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-1056
Mailing Address - Country:US
Mailing Address - Phone:919-731-3200
Mailing Address - Fax:
Practice Address - Street 1:201 STEVENS MILL RD
Practice Address - Street 2:CHERRY HOSPITAL
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-1056
Practice Address - Country:US
Practice Address - Phone:919-731-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherTRICARE
NC6107305Medicaid