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General NPI Number Information
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NPI Number | 1659765147
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Entity Type | Individual
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Provider Name | THOMAS MATTHEWS
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Gender | Male
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 02/19/2018
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Provider Practice Location Address
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Address Line | 16647 WYOMING ST
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City | DETROIT
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State | MI
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Zip | 48221-2848
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Country | US
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Telephone | 313-478-8651
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Fax | 313-861-0413
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Provider Business Mailing Address
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Address Line | 16647 WYOMING ST
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City | DETROIT
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State | MI
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Zip | 48221-2848
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Country | US
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Telephone | 313-478-8651
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Fax | 313-861-0413
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801100616
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License Number State | MI
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