Provider Demographics
NPI:1295466993
Name:MATTESON, JEAN MARIE (LCSW-C, LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:MATTESON
Suffix:
Gender:F
Credentials:LCSW-C, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18447 RIM ROCK CIR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6838
Mailing Address - Country:US
Mailing Address - Phone:301-461-4019
Mailing Address - Fax:
Practice Address - Street 1:18447 RIM ROCK CIR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6838
Practice Address - Country:US
Practice Address - Phone:301-461-4019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040045431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical