Provider Demographics
NPI:1467153445
Name:PEAY-MATTHEWS, MONICA TANISHA (MS,LBS)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:TANISHA
Last Name:PEAY-MATTHEWS
Suffix:
Gender:F
Credentials:MS,LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ANDRIES RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5605
Mailing Address - Country:US
Mailing Address - Phone:215-820-6443
Mailing Address - Fax:
Practice Address - Street 1:10 ANDRIES RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5605
Practice Address - Country:US
Practice Address - Phone:215-820-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH005320103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst