Provider Demographics
NPI:1801027214
Name:MATTHAEI, COURTNEY JILL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:JILL
Last Name:MATTHAEI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 UNION AVE
Mailing Address - Street 2:BUILDING 3, SUITE 20
Mailing Address - City:BRIELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08730-1838
Mailing Address - Country:US
Mailing Address - Phone:732-281-7863
Mailing Address - Fax:732-223-2731
Practice Address - Street 1:617 UNION AVE
Practice Address - Street 2:BUILDING 3, SUITE 20
Practice Address - City:BRIELLE
Practice Address - State:NJ
Practice Address - Zip Code:08730-1838
Practice Address - Country:US
Practice Address - Phone:732-281-7863
Practice Address - Fax:732-223-2731
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTP 053-634103TS0200X
NJ35S100563800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool