Healthcare Provider Details

I. General information

NPI: 1144350299
Provider Name (Legal Business Name): BARBARA MATCHETTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 S WESTERN AVE
MARION IN
46953-5778
US

IV. Provider business mailing address

5230 S WESTERN AVE
MARION IN
46953-5778
US

V. Phone/Fax

Practice location:
  • Phone: 765-674-2208
  • Fax: 765-674-3273
Mailing address:
  • Phone: 765-674-2208
  • Fax: 765-674-3273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003686A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: