Provider Demographics
NPI:1518415306
Name:RADER, MATTHEW (MSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:RADER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S MARKET ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702-7387
Mailing Address - Country:US
Mailing Address - Phone:570-447-0033
Mailing Address - Fax:
Practice Address - Street 1:520 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6038
Practice Address - Country:US
Practice Address - Phone:570-327-4913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health