Provider Demographics
NPI:1649668518
Name:DEBIASE, MATTHEW (MS, NCC,LPC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DEBIASE
Suffix:
Gender:M
Credentials:MS, NCC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1846 MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-1489
Mailing Address - Country:US
Mailing Address - Phone:570-817-8532
Mailing Address - Fax:
Practice Address - Street 1:1172 TWIN STACKS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-8505
Practice Address - Country:US
Practice Address - Phone:570-674-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health