Provider Demographics
NPI:1386363752
Name:MATIAS, JOSELINE KARELY (MSW)
Entity type:Individual
Prefix:
First Name:JOSELINE
Middle Name:KARELY
Last Name:MATIAS
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 1:4326 HANNA ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46806-4742
Mailing Address - Country:US
Mailing Address - Phone:260-209-4529
Mailing Address - Fax:
Practice Address - Street 1:2013 S ANTHONY BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46803-3609
Practice Address - Country:US
Practice Address - Phone:260-209-4529
Practice Address - Fax:260-399-9282
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99112444A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health