Provider Demographics
NPI:1225149545
Name:JONES, MATTHEW D JR (CSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:JONES
Suffix:JR
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18032 SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-2040
Mailing Address - Country:US
Mailing Address - Phone:248-557-1128
Mailing Address - Fax:
Practice Address - Street 1:18032 SUNSET ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-2040
Practice Address - Country:US
Practice Address - Phone:248-557-1128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010334751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68010336475OtherSTATE LICENSE
MIR78322Medicare UPIN
MI0N15270Medicare ID - Type Unspecified