Healthcare Provider Details

I. General information

NPI: 1619236049
Provider Name (Legal Business Name): MATTHEW TODD JARMAN LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 MAIN ST
DOUGLAS MA
01516-2454
US

IV. Provider business mailing address

153 MAIN ST
DOUGLAS MA
01516-2454
US

V. Phone/Fax

Practice location:
  • Phone: 774-482-0995
  • Fax:
Mailing address:
  • Phone: 774-482-0995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number125840
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: