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NPI Code Detail

MEDICARE: MS. DOLORES JANE MATTHEWS MA

MEDICARE:  MS. DOLORES JANE MATTHEWS  MA
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
1103T00000XPsychologist2240MN
2103TC1900XCounseling Psychologist2240MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110946MAOTHERBCBS
21581490OTHERMEDICA

General Provider Information

NPI Number : 1487832564
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DOLORES JANE MATTHEWS MA
Provider Business Mailing Address
First Line : 23 4TH STREET SE
Second Line : #202
City : MINNEAPOLIS
State : MN
Zip : 55414-1090
Country : US
Telephone Number : 612-379-8050
Fax Number : 612-379-8069
Provider Business Practice Location Address
First Line : 23 4TH STREET SE
Second Line : #202
City : MINNEAPOLIS
State : MN
Zip : 55414-1090
Country : US
Telephone Number : 612-379-8050
Fax Number : 612-379-8069
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2008
Last Update Date : 01/31/2008

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Directions to “ MS. DOLORES JANE MATTHEWS MA” Practice Location

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