Provider Demographics
NPI:1336290634
Name:DUSSIA, MATTHEW BERNARD (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:BERNARD
Last Name:DUSSIA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 N COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-8679
Mailing Address - Country:US
Mailing Address - Phone:989-430-7495
Mailing Address - Fax:989-539-2143
Practice Address - Street 1:5818 N COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-8679
Practice Address - Country:US
Practice Address - Phone:989-539-3841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801058358104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker