Provider Demographics
NPI:1982836508
Name:MATHIEU, GRETCHEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:GRETCHEN
Other - Middle Name:MATHIEU
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3900 CITY LINE AVE
Mailing Address - Street 2:SUITE 1207
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2908
Mailing Address - Country:US
Mailing Address - Phone:215-878-3052
Mailing Address - Fax:
Practice Address - Street 1:3900 CITY LINE AVE
Practice Address - Street 2:SUITE 1207
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2908
Practice Address - Country:US
Practice Address - Phone:215-878-3052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-15
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
PA84-019960103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool