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General NPI Number Information
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NPI Number | 1740490853
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Entity Type | Individual
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Provider Name | KATHLEEN C MATTUCCI LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 2475 VILLAGE LN SUITE 102
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City | BILLINGS
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State | MT
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Zip | 59102-2497
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Country | US
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Telephone | 406-259-7288
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Fax | 406-294-0967
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Provider Business Mailing Address
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Address Line | PO BOX 21096
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City | BILLINGS
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State | MT
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Zip | 59104-1096
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Country | US
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Telephone | 406-259-7288
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Fax | 406-294-0967
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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 | 519 LCSW
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License Number State | MT
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