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NPI Code Detail

MEDICARE: CARMELITA ANN MATT MSW, SWLC

MEDICARE: CARMELITA ANN MATT MSW, SWLC
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 WorkerBBH-SWLC-LIC-70496MT

General Provider Information

NPI Number : 1215781083
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARMELITA ANN MATT MSW, SWLC
Provider Business Mailing Address
First Line : PO BOX 1144
Second Line :
City : ST IGNATIUS
State : MT
Zip : 59865-1144
Country : US
Telephone Number : 406-214-1426
Fax Number :
Provider Business Practice Location Address
First Line : 1724 FAIRVIEW AVE STE A
Second Line :
City : MISSOULA
State : MT
Zip : 59801-7873
Country : US
Telephone Number : 406-214-3810
Fax Number : 406-720-7806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2024
Last Update Date : 04/16/2024

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