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NPI Code Detail

MEDICARE: MS. LILITA MATISON LMSW

MEDICARE: MS. LILITA MATISON 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
11041C0700XClinical Social Worker6801106757MI
21041S0200XSchool Social Worker2472910IL

General Provider Information

NPI Number : 1205195591
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LILITA MATISON LMSW
Provider Business Mailing Address
First Line : 2141 AMHERST AVE
Second Line :
City : KALAMAZOO
State : MI
Zip : 49008-3935
Country : US
Telephone Number : 312-823-2702
Fax Number :
Provider Business Practice Location Address
First Line : 5464 HOLIDAY TER
Second Line :
City : KALAMAZOO
State : MI
Zip : 49009-2147
Country : US
Telephone Number : 312-823-2702
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2012
Last Update Date : 02/24/2022

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