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NPI Code Detail

MEDICARE: MR. MATTHEW L NELSON LISW, LICDC

MEDICARE: MR. MATTHEW L NELSON LISW, LICDC
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
11041C0700XClinical Social WorkerI.2405857OH
2101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.162569OH
3104100000XSocial WorkerI.2405857OH

General Provider Information

NPI Number : 1861800898
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW L NELSON LISW, LICDC
Provider Business Mailing Address
First Line : 885 E BUCHTEL AVE
Second Line :
City : AKRON
State : OH
Zip : 44305-2338
Country : US
Telephone Number : 330-535-8116
Fax Number :
Provider Business Practice Location Address
First Line : 885 E BUCHTEL AVE
Second Line :
City : AKRON
State : OH
Zip : 44305-2338
Country : US
Telephone Number : 330-535-8116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2014
Last Update Date : 12/10/2025

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