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General NPI Number Information
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NPI Number | 1043302003
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Entity Type | Individual
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Provider Name | PAUL BERNARD MATENS LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1500 E. WOODROW WILSON DR. DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER (586/122
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City | JACKSON
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State | MS
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Zip | 39216-5591
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Country | US
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Telephone | 601-362-4471
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Fax | 601-368-4093
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Provider Business Mailing Address
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Address Line | 1500 EAST WOODROW WILSON DRIVE DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER (586/122)
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City | JACKSON
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State | MS
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Zip | 39216-5591
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Country | US
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Telephone | 601-362-4471
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Fax | 601-368-4093
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C0732
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License Number State | MS
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