Provider Demographics
NPI:1497770358
Name:MATRICK, DEBRA SARCH (MSW, LCSW, DCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:SARCH
Last Name:MATRICK
Suffix:
Gender:F
Credentials:MSW, LCSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:ROUTE 390
Mailing Address - City:MOUNTAINHOME
Mailing Address - State:PA
Mailing Address - Zip Code:18342-0108
Mailing Address - Country:US
Mailing Address - Phone:570-595-0943
Mailing Address - Fax:570-595-0969
Practice Address - Street 1:1101 RTE 390
Practice Address - Street 2:SUITE 102
Practice Address - City:CRESCO
Practice Address - State:PA
Practice Address - Zip Code:18326
Practice Address - Country:US
Practice Address - Phone:570-595-0943
Practice Address - Fax:570-595-0969
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW008764L1041C0700X
NJ44SC002045001041C0700X
NJ37F100138600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA643878Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PA837801Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER