Provider Demographics
NPI:1043302003
Name:MATENS, PAUL BERNARD (LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:BERNARD
Last Name:MATENS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 EAST WOODROW WILSON DRIVE
Mailing Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER (586/122)
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5591
Mailing Address - Country:US
Mailing Address - Phone:601-362-4471
Mailing Address - Fax:601-368-4093
Practice Address - Street 1:1500 E. WOODROW WILSON DR.
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER (586/122
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5591
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:601-368-4093
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC07321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical