Provider Demographics
NPI:1326327909
Name:MATKO, NICOLE LEE ANN (BA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEE ANN
Last Name:MATKO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:LEE ANN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19578 ROUTE 286 HWY E
Mailing Address - Street 2:
Mailing Address - City:CHERRY TREE
Mailing Address - State:PA
Mailing Address - Zip Code:15724-7901
Mailing Address - Country:US
Mailing Address - Phone:724-422-8752
Mailing Address - Fax:
Practice Address - Street 1:1380 ROUTE 286 HWY E
Practice Address - Street 2:SUITE 524
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-1461
Practice Address - Country:US
Practice Address - Phone:724-465-0369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health