Provider Demographics
NPI:1215752282
Name:MATULLO-MILLER, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MATULLO-MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14336 NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:CLEAR SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:21722-1729
Mailing Address - Country:US
Mailing Address - Phone:443-624-5438
Mailing Address - Fax:
Practice Address - Street 1:14336 NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:CLEAR SPRING
Practice Address - State:MD
Practice Address - Zip Code:21722-1729
Practice Address - Country:US
Practice Address - Phone:443-624-5438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool