Provider Demographics
NPI:1447597422
Name:MATLACK, MARGARET EILEEN (PHD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:EILEEN
Last Name:MATLACK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 E MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2809
Mailing Address - Country:US
Mailing Address - Phone:410-334-6363
Mailing Address - Fax:
Practice Address - Street 1:132 E MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2809
Practice Address - Country:US
Practice Address - Phone:410-334-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0778101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor