Provider Demographics
NPI: | 1134691322 |
---|---|
Name: | ROTA MATTHEWS, JEANNE ELIZABETH (MA, MED, PSYD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | JEANNE |
Middle Name: | ELIZABETH |
Last Name: | ROTA MATTHEWS |
Suffix: | |
Gender: | F |
Credentials: | MA, MED, PSYD |
Other - Prefix: | DR |
Other - First Name: | JEANNE |
Other - Middle Name: | ELIZABETH |
Other - Last Name: | ROTA |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | MA, MED, PAYD |
Mailing Address - Street 1: | 1047 MARKEE TER |
Mailing Address - Street 2: | |
Mailing Address - City: | BRYN MAWR |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19010-3003 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 484-588-1523 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1047 MARKEE TER |
Practice Address - Street 2: | |
Practice Address - City: | BRYN MAWR |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19010-3003 |
Practice Address - Country: | US |
Practice Address - Phone: | 484-588-1523 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2018-12-28 |
Last Update Date: | 2018-12-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | ||
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | |
No | 101YS0200X | Behavioral Health & Social Service Providers | Counselor | School | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | ||
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | |
No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | |
No | 103TE1100X | Behavioral Health & Social Service Providers | Psychologist | Exercise & Sports | |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic | Group - Multi-Specialty |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |