Provider Demographics
NPI:1235649898
Name:CARLETON, MATTHEW (LLMSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:CARLETON
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27188 ROBIN DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-3191
Mailing Address - Country:US
Mailing Address - Phone:586-980-2464
Mailing Address - Fax:
Practice Address - Street 1:2 CROCKER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2558
Practice Address - Country:US
Practice Address - Phone:586-468-2266
Practice Address - Fax:586-468-4505
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801101544104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker