Provider Demographics
NPI:1407676703
Name:MATTHEWS, ROBERT A (LPC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 WOODWARD ST APT 604
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-5123
Mailing Address - Country:US
Mailing Address - Phone:267-879-6779
Mailing Address - Fax:
Practice Address - Street 1:2375 WOODWARD ST APT 604
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-5123
Practice Address - Country:US
Practice Address - Phone:267-879-6779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017730101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional