Provider Demographics
NPI:1710710686
Name:MATTHEWS, ROBERTA ANNE
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:ANNE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:ANNE
Other - Last Name:GRIFFITHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPED TEACHER
Mailing Address - Street 1:130 LOMOND CT
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5957
Mailing Address - Country:US
Mailing Address - Phone:315-724-4286
Mailing Address - Fax:
Practice Address - Street 1:130 LOMOND CT
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5957
Practice Address - Country:US
Practice Address - Phone:315-724-4286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322981901174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist