Provider Demographics
NPI:1992555783
Name:MATTHEWS, CAROLE RENEE
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:RENEE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 BUTLER ST SE APT 103
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4372
Mailing Address - Country:US
Mailing Address - Phone:202-413-4297
Mailing Address - Fax:
Practice Address - Street 1:3109 MARTIN LUTHER KING JR AVE SE APT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1576
Practice Address - Country:US
Practice Address - Phone:202-800-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator