Provider Demographics
NPI:1043990203
Name:CALDWELL, MATTHEW ALBERT (PMHNP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALBERT
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-1707
Mailing Address - Country:US
Mailing Address - Phone:717-433-2884
Mailing Address - Fax:
Practice Address - Street 1:17 GLENVIEW AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1707
Practice Address - Country:US
Practice Address - Phone:717-433-2884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027858363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health