Provider Demographics
NPI:1386849024
Name:ATWOOD, MATTHEW (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:ATWOOD
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 1:2820 QUAY LOOP APT A
Mailing Address - Street 2:
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330-8192
Mailing Address - Country:US
Mailing Address - Phone:505-479-1228
Mailing Address - Fax:
Practice Address - Street 1:200 FIRST ST.
Practice Address - Street 2:BLDG 17
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330
Practice Address - Country:US
Practice Address - Phone:505-572-5676
Practice Address - Fax:505-572-1523
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5687104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker