NPIMap

Individual provider Active NPI

Marlena Nicole Matusewicz, PSY.D.

  • Clinical Neuropsychologist
  • Charlotte, NC
National Provider Identifier
1588705248
Registry record updated Dec 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
4499 Issued in NC
Practice address
501 Billingsley Rd
Charlotte, NC 28211-1009
Phone
(704) 358-2744
Fax
(704) 358-2945
NPI assigned
Feb 8, 2007
Last updated
Dec 28, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Neuropsychologist 103G00000X 4499 NC Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

501 Billingsley Rd
Charlotte, NC 28211-1009

Mailing address

PO Box 601067
Charlotte, NC 28260-1067
Phone (704) 358-2744

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140102001239 NC Practitioner - Clinical Psychologist 2567690225 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas RehabilitationGroup PAC ID 1557256351, 5 clinicians

Practice addresses (Care Compare)

1100 Blythe Blvd
Charlotte, NC 28203-5814
Phone (704) 355-4300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4499NCMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Rehabilitation CurrentSince Dec 10, 2018 Accepting new patients
Carolinas Rehabilitation CurrentSince Dec 10, 2018 Accepting new patients

Locations

1100 Blythe Blvd
Charlotte, NC 28203
Phone (704) 355-4300

Interoperability endpoints

  • Direct secure messaging: mmatusewicz269475@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482883200000",
    "number": "1588705248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601067",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601067",
            "telephone_number": "704-358-2744",
            "fax_number": "704-358-2945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 BILLINGSLEY RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111009",
            "telephone_number": "704-358-2744",
            "fax_number": "704-358-2945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATUSEWICZ",
        "first_name": "MARLENA",
        "middle_name": "NICOLE",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2016-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NC",
            "license": "4499",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.