Provider Demographics
NPI:1063658615
Name:MUSGRAVE, MATHEW JOE (MSSW, LISW-S)
Entity Type:Individual
Prefix:MR
First Name:MATHEW
Middle Name:JOE
Last Name:MUSGRAVE
Suffix:
Gender:M
Credentials:MSSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12314 TOWNSHIP ROAD 152
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45814-9766
Mailing Address - Country:US
Mailing Address - Phone:419-365-5418
Mailing Address - Fax:
Practice Address - Street 1:2001 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2241
Practice Address - Country:US
Practice Address - Phone:419-726-7977
Practice Address - Fax:419-726-7157
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0007155-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical