Provider Demographics
NPI:1063435881
Name:MATTHEWS, LAURA H (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:H
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 EDMAR RD
Mailing Address - Street 2:
Mailing Address - City:E FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-4632
Mailing Address - Country:US
Mailing Address - Phone:508-540-8440
Mailing Address - Fax:508-775-1245
Practice Address - Street 1:1019 IYANNOUGH RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1839
Practice Address - Country:US
Practice Address - Phone:508-778-1839
Practice Address - Fax:508-775-1245
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1119731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23513Medicare ID - Type Unspecified