Provider Demographics
NPI:1164188439
Name:MATTISE-NAUMAN, ALEXA (LSW)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:MATTISE-NAUMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 N PARK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1341
Mailing Address - Country:US
Mailing Address - Phone:610-396-5094
Mailing Address - Fax:
Practice Address - Street 1:833 N PARK RD STE 101
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1341
Practice Address - Country:US
Practice Address - Phone:610-396-5094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138404104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker