Provider Demographics
NPI:1164809315
Name:CUMMINGS, MATHEW JOHN (LICSW)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:JOHN
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 GILLMORE AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3302
Mailing Address - Country:US
Mailing Address - Phone:509-946-8778
Mailing Address - Fax:
Practice Address - Street 1:1110 GILLMORE AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3302
Practice Address - Country:US
Practice Address - Phone:509-946-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000080551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical