MEDICARE: MARTIN MATHEWS LCDCIII, CADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCIII.161910	OH

General Provider Information

NPI Number	:	1093276032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN MATHEWS LCDCIII, CADC

Provider Business Mailing Address
First Line	:	6460 HARRISON AVE STE 200
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7821
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6460 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7821
Country	:	US
Telephone Number	:	513-941-4999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2019
Last Update Date	:	10/10/2025

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