Provider Demographics
NPI:1558463760
Name:MATTHEWS, BEVERLY J (PSYD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:J
Last Name:MATTHEWS
Suffix:
Gender:F
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:PO BOX 2416
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62524-2416
Mailing Address - Country:US
Mailing Address - Phone:217-825-9010
Mailing Address - Fax:
Practice Address - Street 1:3517 CARNOUSTIE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62712
Practice Address - Country:US
Practice Address - Phone:217-529-4851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist