Provider Demographics
NPI:1114116241
Name:STEVENS, MATTHEW DAVIS (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DAVIS
Last Name:STEVENS
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6239 MEADOWCROFT RD
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6127
Mailing Address - Country:US
Mailing Address - Phone:443-800-4714
Mailing Address - Fax:
Practice Address - Street 1:8840 STANFORD BLVD STE 1600
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5909
Practice Address - Country:US
Practice Address - Phone:240-512-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD150701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD609500300Medicaid