Provider Demographics
NPI:1922866334
Name:MATHEWS, MARIELLE MARTINO (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIELLE
Middle Name:MARTINO
Last Name:MATHEWS
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 1:531 FAIRFAX RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1210
Mailing Address - Country:US
Mailing Address - Phone:610-613-2069
Mailing Address - Fax:
Practice Address - Street 1:531 FAIRFAX RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1210
Practice Address - Country:US
Practice Address - Phone:610-613-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018751103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist