Provider Demographics
NPI:1154472132
Name:MATZ, MIRIAM RICHTER (PSYD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:RICHTER
Last Name:MATZ
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 1:6 HUMPHREYS AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1116
Mailing Address - Country:US
Mailing Address - Phone:856-467-1000
Mailing Address - Fax:856-467-1150
Practice Address - Street 1:545 BECKETT RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1547
Practice Address - Country:US
Practice Address - Phone:856-467-1000
Practice Address - Fax:856-467-1150
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015665103G00000X
NJ5117103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA090204RCDMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER