Provider Demographics
NPI:1043643307
Name:GROGAN, MATTHEW PAUL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PAUL
Last Name:GROGAN
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 1:1205 9TH ST NE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-1207
Mailing Address - Country:US
Mailing Address - Phone:256-832-4153
Mailing Address - Fax:
Practice Address - Street 1:96 ALI WAY
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1835
Practice Address - Country:US
Practice Address - Phone:256-832-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3564C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical