Provider Demographics
NPI:1952462095
Name:VERGHESE, MATTHEW (LCSW, MFT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:VERGHESE
Suffix:
Gender:M
Credentials:LCSW, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 WELSH ROAD SUITE 202
Mailing Address - Street 2:PHILMONT GUIDANCE CENTER
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:19006
Mailing Address - Country:US
Mailing Address - Phone:215-914-2119
Mailing Address - Fax:215-914-1663
Practice Address - Street 1:727 WELSH ROAD SUITE 202
Practice Address - Street 2:PHILMONT GUIDANCE CENTER
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:19006
Practice Address - Country:US
Practice Address - Phone:215-914-2119
Practice Address - Fax:215-914-1663
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0137581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
031900GHEMedicare ID - Type Unspecified