Healthcare Provider Details

I. General information

NPI: 1699662577
Provider Name (Legal Business Name): CHARLES MATHEWS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S BROAD ST STE 402
PHILADELPHIA PA
19102-4108
US

IV. Provider business mailing address

781 N JUDSON ST
PHILADELPHIA PA
19130-2507
US

V. Phone/Fax

Practice location:
  • Phone: 215-282-3004
  • Fax:
Mailing address:
  • Phone: 215-282-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW142823
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: