Provider Demographics
NPI:1407405772
Name:MATHERNE, ANGELA (LMSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MATHERNE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 BIRNEY ST
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-1671
Mailing Address - Country:US
Mailing Address - Phone:734-389-5218
Mailing Address - Fax:
Practice Address - Street 1:3175 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2823
Practice Address - Country:US
Practice Address - Phone:989-667-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI68011135691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty