Provider Demographics
NPI:1770219255
Name:MATHIEU, MARSHA (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2026
Mailing Address - Country:US
Mailing Address - Phone:718-877-5938
Mailing Address - Fax:
Practice Address - Street 1:7452 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3547
Practice Address - Country:US
Practice Address - Phone:443-374-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional