Healthcare Provider Details

I. General information

NPI: 1043791866
Provider Name (Legal Business Name): JOHN J MATTHEWS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12550 NEW BRITTANY BLVD STE 100
FORT MYERS FL
33907
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9180
  • Fax: 239-343-9183
Mailing address:
  • Phone: 239-343-9180
  • Fax: 239-343-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020032
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16359
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberCW020032
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: