Healthcare Provider Details

I. General information

NPI: 1578546982
Provider Name (Legal Business Name): CLARE BRADY MATTHEWS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 S MAIN ST
WOODSTOCK VA
22664-1451
US

IV. Provider business mailing address

144 N MAIN ST
WOODSTOCK VA
22664-1417
US

V. Phone/Fax

Practice location:
  • Phone: 540-335-1254
  • Fax: 540-459-4970
Mailing address:
  • Phone: 540-459-4946
  • Fax: 540-459-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005393
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: