Provider Demographics
NPI:1326437286
Name:MATHEWS, MERISSA ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:MERISSA
Middle Name:ANNE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21589 PUMICE LN
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-6935
Mailing Address - Country:US
Mailing Address - Phone:760-473-6810
Mailing Address - Fax:
Practice Address - Street 1:41870 KALMIA ST STE 155
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8850
Practice Address - Country:US
Practice Address - Phone:951-523-7571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW640771041C0700X
CALCSW802271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical