MEDICARE: TREKINYA MATTHEWS LLMSW

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	1041S0200X	School Social Worker	6801091505	MI

General Provider Information

NPI Number	:	1588071062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREKINYA MATTHEWS LLMSW

Provider Business Mailing Address
First Line	:	45 E BUENA VISTA ST
Second Line	:
City	:	HIGHLAND PARK
State	:	MI
Zip	:	48203-3343
Country	:	US
Telephone Number	:	313-865-0356
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 E BUENA VISTA ST
Second Line	:
City	:	HIGHLAND PARK
State	:	MI
Zip	:	48203-3343
Country	:	US
Telephone Number	:	313-865-0356
Fax Number	:

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

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	07/17/2014

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