Provider Demographics
NPI:1235361874
Name:MATAMOROS, KARLA (LSW)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:MATAMOROS
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 1:52 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5948
Mailing Address - Country:US
Mailing Address - Phone:484-550-5189
Mailing Address - Fax:610-867-2848
Practice Address - Street 1:52 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5948
Practice Address - Country:US
Practice Address - Phone:484-550-5189
Practice Address - Fax:610-867-2848
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-16
Last Update Date:2009-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW124043104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker