Provider Demographics
NPI:1164750113
Name:MATIG, KARLA MAE (LSW)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:MAE
Last Name:MATIG
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:OH
Mailing Address - Zip Code:44437-1940
Mailing Address - Country:US
Mailing Address - Phone:330-240-0690
Mailing Address - Fax:
Practice Address - Street 1:165 E PARK AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-2352
Practice Address - Country:US
Practice Address - Phone:330-544-8005
Practice Address - Fax:330-544-9379
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0025963104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker