Provider Demographics
NPI:1285900761
Name:DEBORAH C MATSON, MSW INC
Entity type:Organization
Organization Name:DEBORAH C MATSON, MSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:CONSTANCE
Authorized Official - Last Name:MATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:401-455-0799
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:401-455-0799
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW003351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty