Provider Demographics
NPI:1124217609
Name:MCMATH, ELISE M (LISW)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:M
Last Name:MCMATH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-9511
Mailing Address - Country:US
Mailing Address - Phone:740-454-9766
Mailing Address - Fax:
Practice Address - Street 1:1375 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-9511
Practice Address - Country:US
Practice Address - Phone:740-454-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI07003871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical