=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215073119
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH C MATSON MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 03/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 331 BROADWAY
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02909-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-455-0799
-----------------------------------------------------
Fax | 401-454-2773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 88 WINDWARD LN
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02809-1551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-253-3541
-----------------------------------------------------
Fax | 401-454-2773
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | ISW00335
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 107666
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------