Provider Demographics
NPI:1376235325
Name:MATTHEWS, AMMIES GEORGE
Entity Type:Individual
Prefix:
First Name:AMMIES
Middle Name:GEORGE
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 VINSON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3990
Mailing Address - Country:US
Mailing Address - Phone:774-225-4792
Mailing Address - Fax:
Practice Address - Street 1:19 VINSON ST APT 2
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3990
Practice Address - Country:US
Practice Address - Phone:774-225-4792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty