MEDICARE: MR. MATTHEW D. JONES JR. C.S.W.

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	6801033475	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68010336475	OTHER	MI	STATE LICENSE

General Provider Information

NPI Number	:	1225149545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW D. JONES JR. C.S.W.

Provider Business Mailing Address
First Line	:	18032 SUNSET ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-2040
Country	:	US
Telephone Number	:	248-557-1128
Fax Number	:

Provider Business Practice Location Address
First Line	:	18032 SUNSET ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-2040
Country	:	US
Telephone Number	:	248-557-1128
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	02/20/2013

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Directions to “ MR. MATTHEW D. JONES JR. C.S.W.” Practice Location

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