Provider Demographics
NPI:1174757678
Name:MATUSIAK, ALICJA (LISW-S, CNP)
Entity type:Individual
Prefix:MRS
First Name:ALICJA
Middle Name:
Last Name:MATUSIAK
Suffix:
Gender:F
Credentials:LISW-S, CNP
Other - Prefix:
Other - First Name:ALICJA
Other - Middle Name:
Other - Last Name:GRIFFITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4770 INDIANOLA AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1862
Mailing Address - Country:US
Mailing Address - Phone:614-371-2303
Mailing Address - Fax:800-905-9950
Practice Address - Street 1:4770 INDIANOLA AVE STE 107
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1862
Practice Address - Country:US
Practice Address - Phone:614-371-2303
Practice Address - Fax:800-905-9950
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08003451041C0700X
OH359101163WH0200X
OHCOA.16032-NP363LP0808X
OHAPRN.CNP.16032363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0116587Medicaid