Provider Demographics
NPI:1033272737
Name:MATUELLA, ANGELA JOYCE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JOYCE
Last Name:MATUELLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5056 ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WOODGATE
Mailing Address - State:NY
Mailing Address - Zip Code:13494-2015
Mailing Address - Country:US
Mailing Address - Phone:201-230-0524
Mailing Address - Fax:315-392-2053
Practice Address - Street 1:5056 ELMWOOD RD
Practice Address - Street 2:
Practice Address - City:WOODGATE
Practice Address - State:NY
Practice Address - Zip Code:13494-2015
Practice Address - Country:US
Practice Address - Phone:201-230-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047387001041C0700X
NYR055827-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP035637Medicare UPIN