MEDICARE: SUSAN G MATLAS LMSW, LMFT

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	104100000X	Social Worker	6801015677	MI
2	106H00000X	Marriage & Family Therapist	4101005550	MI

General Provider Information

NPI Number	:	1942233861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN G MATLAS LMSW, LMFT

Provider Business Mailing Address
First Line	:	28000 DEQUINDRE RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48092-2468
Country	:	US
Telephone Number	:	586-753-0405
Fax Number	:	586-753-0404

Provider Business Practice Location Address
First Line	:	5111 AUTO CLUB DR
Second Line	:	#120
City	:	DEARBORN
State	:	MI
Zip	:	48126-2749
Country	:	US
Telephone Number	:	313-583-0735
Fax Number	:	313-583-0751

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	09/11/2025

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