Provider Demographics
NPI:1326363623
Name:MATOTEK, MICHAEL (MED CAC LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MATOTEK
Suffix:
Gender:M
Credentials:MED CAC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 WEST BEAVER ROAD
Mailing Address - Street 2:GLADE RUN
Mailing Address - City:ZELIENOPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063-2336
Mailing Address - Country:US
Mailing Address - Phone:724-452-4453
Mailing Address - Fax:724-452-6576
Practice Address - Street 1:1008 7TH AVE STE 210
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-4558
Practice Address - Country:US
Practice Address - Phone:724-843-0816
Practice Address - Fax:724-843-0818
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000684101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)