Provider Demographics
NPI:1902104524
Name:MAURIELLO, MATTHEW JOSEPH (MA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:MAURIELLO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HAWTHORNE CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3918
Mailing Address - Country:US
Mailing Address - Phone:814-934-7960
Mailing Address - Fax:
Practice Address - Street 1:139 W MARKET ST STE D
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-2912
Practice Address - Country:US
Practice Address - Phone:814-934-7960
Practice Address - Fax:888-976-5828
Is Sole Proprietor?:No
Enumeration Date:2011-03-06
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005810101YM0800X, 101YP2500X
PABH000583103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst