Provider Demographics
| NPI: | 1134691322 |
|---|---|
| Name: | ROTA MATTHEWS, JEANNE ELIZABETH (MA, MED, PSYD) |
| Entity type: | Individual |
| Prefix: | DR |
| First Name: | JEANNE |
| Middle Name: | ELIZABETH |
| Last Name: | ROTA MATTHEWS |
| Suffix: | |
| Gender: | F |
| Credentials: | MA, MED, PSYD |
| Other - Prefix: | DR |
| Other - First Name: | JEANNE |
| Other - Middle Name: | ELIZABETH |
| Other - Last Name: | ROTA |
| Other - Suffix: | |
| Other - Last Name Type: | Former Name |
| Other - Credentials: | MA, MED, PAYD |
| Mailing Address - Street 1: | 1047 MARKEE TER |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BRYN MAWR |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 19010-3003 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 484-588-1523 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 1047 MARKEE TER |
| Practice Address - Street 2: | |
| Practice Address - City: | BRYN MAWR |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 19010-3003 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 484-588-1523 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2018-12-28 |
| Last Update Date: | 2018-12-28 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | ||
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | |
| No | 101YS0200X | Behavioral Health & Social Service Providers | Counselor | School | |
| No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | ||
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | |
| No | 103TE1100X | Behavioral Health & Social Service Providers | Psychologist | Exercise & Sports | |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
| No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic | Group - Multi-Specialty |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
