Provider Demographics
NPI:1376179861
Name:MATT, ELYSE (MS ED)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:MATT
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LEE DR APT 13
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-1213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:807 WALLACE AVE STE 102
Practice Address - Street 2:
Practice Address - City:WILKINSBURG
Practice Address - State:PA
Practice Address - Zip Code:15221-2312
Practice Address - Country:US
Practice Address - Phone:412-760-9574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health