MEDICARE: MR. LANCE LEE MATTHEWSON LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SWB-2026-0124	NM

General Provider Information

NPI Number	:	1154976850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LANCE LEE MATTHEWSON LMSW

Provider Business Mailing Address
First Line	:	1557 LA CIENEGUITA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-5658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1557 LA CIENEGUITA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-5658
Country	:	US
Telephone Number	:	505-819-8210
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	03/09/2026

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