Provider Demographics
NPI:1992329965
Name:VANDER MATEN, ABBIE MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:ABBIE
Middle Name:MARIE
Last Name:VANDER MATEN
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 1:6120 EARLE BROWN DR STE 520
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-4112
Mailing Address - Country:US
Mailing Address - Phone:763-531-0566
Mailing Address - Fax:
Practice Address - Street 1:6120 EARLE BROWN DR STE 520
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-4112
Practice Address - Country:US
Practice Address - Phone:763-531-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN217651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical