Provider Demographics
NPI:1013103571
Name:MATYKA, JESSICA A (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:MATYKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 PADDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7044
Mailing Address - Country:US
Mailing Address - Phone:203-634-7416
Mailing Address - Fax:203-630-5335
Practice Address - Street 1:883 PADDOCK AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-7044
Practice Address - Country:US
Practice Address - Phone:203-634-7416
Practice Address - Fax:203-630-5335
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT78171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare UPIN