Provider Demographics
NPI:1194140848
Name:MATTHEWS, JESSE D (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:D
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 LITTLE CONESTOGA RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-9562
Mailing Address - Country:US
Mailing Address - Phone:610-482-4496
Mailing Address - Fax:
Practice Address - Street 1:157 LITTLE CONESTOGA RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-9562
Practice Address - Country:US
Practice Address - Phone:610-482-4496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017518103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical