Provider Demographics
NPI:1275552770
Name:MATTHIAS, AMANDA K (LISW-S)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:MATTHIAS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 E CENTERVILLE STATION RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-5500
Mailing Address - Country:US
Mailing Address - Phone:937-439-2984
Mailing Address - Fax:937-439-2984
Practice Address - Street 1:7061 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4273
Practice Address - Country:US
Practice Address - Phone:937-304-1615
Practice Address - Fax:937-439-2984
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0009389104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0251930Medicaid