Provider Demographics
NPI:1235899402
Name:MATTHEWS, JOANNA POISTRASAGOCS (MED)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:POISTRASAGOCS
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 ARGYLE RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1951
Mailing Address - Country:US
Mailing Address - Phone:267-994-3704
Mailing Address - Fax:
Practice Address - Street 1:210 MALL BLVD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3261
Practice Address - Country:US
Practice Address - Phone:484-808-5340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPC014012101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional