Healthcare Provider Details

I. General information

NPI: 1861800898
Provider Name (Legal Business Name): MATTHEW L NELSON LISW, LICDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 E BUCHTEL AVE
AKRON OH
44305-2338
US

IV. Provider business mailing address

885 E BUCHTEL AVE
AKRON OH
44305-2338
US

V. Phone/Fax

Practice location:
  • Phone: 330-535-8116
  • Fax:
Mailing address:
  • Phone: 330-535-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2405857
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162569
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2405857
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: