MEDICARE: MR. MATTHEW DAVIS STEVENS LCSW-C

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	1041C0700X	Clinical Social Worker	15070	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114116241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW DAVIS STEVENS LCSW-C

Provider Business Mailing Address
First Line	:	6239 MEADOWCROFT RD
Second Line	:
City	:	ELDERSBURG
State	:	MD
Zip	:	21784-6127
Country	:	US
Telephone Number	:	443-800-4714
Fax Number	:

Provider Business Practice Location Address
First Line	:	8840 STANFORD BLVD STE 1600
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5909
Country	:	US
Telephone Number	:	240-512-0141
Fax Number	:

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

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	09/21/2019

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