Provider Demographics
NPI:1699044214
Name:MATT SHOLLENBERGER, PH.D, PC
Entity type:Organization
Organization Name:MATT SHOLLENBERGER, PH.D, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MATT SHOLLENBERGER, PH.D, PC
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOLLENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:484-459-6423
Mailing Address - Street 1:906 PENN AVENUE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3007
Mailing Address - Country:US
Mailing Address - Phone:484-459-6423
Mailing Address - Fax:610-399-3602
Practice Address - Street 1:1306 OLD WILMINGTON PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382
Practice Address - Country:US
Practice Address - Phone:484-459-6482
Practice Address - Fax:610-399-3602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATT SHOLLENBERGER, PH.D. PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-28
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty