MEDICARE: STEVEN DON MATHEWS LCSW

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	5816	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	265906	OTHER	LA	COMPSYCH

General Provider Information

NPI Number	:	1184751919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN DON MATHEWS LCSW

Provider Business Mailing Address
First Line	:	125 GREEN OAKS DR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-2719
Country	:	US
Telephone Number	:	337-988-1271
Fax Number	:	337-988-1272

Provider Business Practice Location Address
First Line	:	218 RUE LOUIS XIV STE A
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-5766
Country	:	US
Telephone Number	:	337-988-1271
Fax Number	:	337-988-1272

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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