Healthcare Provider Details

I. General information

NPI: 1295286029
Provider Name (Legal Business Name): MATTHEW HOLDEN L.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

450 S 5TH ST
READING PA
19602-2642
US

V. Phone/Fax

Practice location:
  • Phone: 302-320-2100
  • Fax:
Mailing address:
  • Phone: 610-372-5645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW130225
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001603
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: