Provider Demographics
NPI:1831350909
Name:STEFANELLI, MATTHEW JOSEPH (MS, LPC, CAC DP)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:STEFANELLI
Suffix:
Gender:M
Credentials:MS, LPC, CAC DP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1362
Mailing Address - Country:US
Mailing Address - Phone:570-351-3089
Mailing Address - Fax:570-489-1464
Practice Address - Street 1:1714 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:PA
Practice Address - Zip Code:18447-1362
Practice Address - Country:US
Practice Address - Phone:570-351-3089
Practice Address - Fax:570-489-1464
Is Sole Proprietor?:No
Enumeration Date:2008-06-21
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004628101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional