Provider Demographics
NPI:1659409019
Name:MATTA, JAMES KERNAN SR (EDD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KERNAN
Last Name:MATTA
Suffix:SR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 MCCASLIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2629
Mailing Address - Country:US
Mailing Address - Phone:412-521-6989
Mailing Address - Fax:412-246-6550
Practice Address - Street 1:UNION PLACE BUILDING, FIFTH FLOOR
Practice Address - Street 2:801 UNION PLACE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212
Practice Address - Country:US
Practice Address - Phone:412-321-4333
Practice Address - Fax:412-586-2119
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000005101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional