Michele Mattie, PHD, LLC

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PS008609L Issued in PA

Legal business name

MICHELE MATTIE, PHD, LLC

Practice address

517 Pierce St
Suite B
Kingston, PA 18704-5731

Phone

(570) 718-1150

Fax

(570) 714-1321

NPI assigned

Sep 1, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michele Mattie, PHDNPI 1285665075

Title

Owner

Phone

(570) 718-1150

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michele Mattie, PHD

  • Psychologist
  • Kingston, PA
  • NPI 1285665075
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477655314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 PIERCE ST",
            "address_2": "SUITE B",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187045731",
            "telephone_number": "570-718-1150",
            "fax_number": "570-714-1321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 PIERCE ST",
            "address_2": "SUITE B",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187045731",
            "telephone_number": "570-718-1150",
            "fax_number": "570-714-1321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHELE MATTIE, PHD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MATTIE",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-718-1150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "PA",
            "license": "PS008609L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1285665075",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "359151",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carlo Anthony Mercadante, LAT, ATC
• William R Mericle, LCSW
• Leah Alexandra Merrick, PA-C
• Michael E Fath, D.O., P.C
• Michael F. Lombard MD Stanley a. Lobitz MD Gen PTRS
• Richard D Michelstein, M.D.
• Thomas Mickowski, CRNP
• Allison Middleton, LSW
• Eileen Catherine Miller, OTR/L
• Jennifer Christine Miller, COTA

• Clinical Child & Adolescent Psychologist in Kingston, PA
• Providers in Kingston, PA by specialty
• Clinical Child & Adolescent Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.