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NPI Code Detail

MEDICARE: DOMINIQUE MATTHEWS LLBSW

MEDICARE: DOMINIQUE MATTHEWS LLBSW
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
1104100000XSocial Worker6802088207MI

General Provider Information

NPI Number : 1982091971
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIQUE MATTHEWS LLBSW
Provider Business Mailing Address
First Line : 9641 HARPER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48213-2731
Country : US
Telephone Number : 313-875-7601
Fax Number :
Provider Business Practice Location Address
First Line : 9641 HARPER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48213-2731
Country : US
Telephone Number : 313-875-7601
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2015
Last Update Date : 04/17/2015

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Directions to “ DOMINIQUE MATTHEWS LLBSW” Practice Location

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