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General NPI Number Information
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NPI Number | 1275062366
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Entity Type | Individual
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Provider Name | DORENE LOIS MATHEWS LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 06/12/2017
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Provider Practice Location Address
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Address Line | 799 HOMBACH ST
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City | SAINT IGNACE
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State | MI
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Zip | 49781-1735
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Country | US
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Telephone | 906-984-2300
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Fax |
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Provider Business Mailing Address
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Address Line | N4435 SCHOOL HOUSE RD
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City | MORAN
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State | MI
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Zip | 49760-0124
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Country | US
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Telephone | 906-280-0845
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Fax |
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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 | 6801077861
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License Number State | MI
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