Marlena Nicole Matusewicz, PSY.D.
Individual provider Active NPI Clinical Neuropsychologist · Charlotte, NC
NPI 1588705248 · NPPES record last updated Dec 28, 2016
Key facts
- NPI
- 1588705248
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Neuropsychologist 103G00000X
- License
- 4499 (NC)
- Practice address
- 501 Billingsley Rd
Charlotte, NC 28211-1009 - Phone
- (704) 358-2744
- Fax
- (704) 358-2945
- NPI assigned
- Feb 8, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Carolinas Rehabilitation
Practice addresses (Care Compare)
1100 Blythe Blvd
Charlotte, NC 28203-5814
Phone (704) 355-4300
Hospital & facility affiliations
- Carolinas Medical Center/Behav Health
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140102001239 | NC | Practitioner - Clinical Psychologist | 2567690225 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4499 | NC | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolinas Rehabilitation | Current |
Accepting new patients | |
| Carolinas Rehabilitation | Current |
Accepting new patients |
Locations
1100 Blythe Blvd
Charlotte, NC 28203
Phone (704) 355-4300
Interoperability endpoints
- mmatusewicz269475@carolinashealthcaresystem.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Clinical Neuropsychologist | 103G00000X | 4499 | NC | Yes |
| 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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588705248 | Medicaid | NC | |
| PS0538 | Medicaid | SC |
Other providers in Charlotte, NC
- Lillie Mattox
- Sandra Gay Mattson
- Lisa Michelle Matuga
- Justin Thomas Matulay
- Melissa Dawne Matulis
- Jeffrey Earle Matz
- Arielle Christina Mauceri
- David R Mauerhan
- Christeen Mauerman
- Camiya Maul-Pierre
All providers in Charlotte, NC · Clinical Neuropsychologist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.