Provider Demographics
NPI:1215073119
Name:MATSON, DEBORAH C (MSW)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:C
Last Name:MATSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 WINDWARD LN
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-1551
Mailing Address - Country:US
Mailing Address - Phone:401-253-3541
Mailing Address - Fax:401-454-2773
Practice Address - Street 1:331 BROADWAY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1101
Practice Address - Country:US
Practice Address - Phone:401-455-0799
Practice Address - Fax:401-454-2773
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW003351041C0700X
MA1076661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical