Healthcare Provider Details

I. General information

NPI: 1043302003
Provider Name (Legal Business Name): PAUL BERNARD MATENS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E. WOODROW WILSON DR. DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER (586/122
JACKSON MS
39216-5591
US

IV. Provider business mailing address

1500 EAST WOODROW WILSON DRIVE DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER (586/122)
JACKSON MS
39216-5591
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-4471
  • Fax: 601-368-4093
Mailing address:
  • Phone: 601-362-4471
  • Fax: 601-368-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC0732
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: