Provider Demographics
NPI:1467554899
Name:MATTHEWS, EDWIN WILLIAM JR (SOCIAL WORKER)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:WILLIAM
Last Name:MATTHEWS
Suffix:JR
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:MI
Mailing Address - Zip Code:48097-2994
Mailing Address - Country:US
Mailing Address - Phone:810-387-3232
Mailing Address - Fax:
Practice Address - Street 1:516 NORTH ST
Practice Address - Street 2:
Practice Address - City:YALE
Practice Address - State:MI
Practice Address - Zip Code:48097-2994
Practice Address - Country:US
Practice Address - Phone:810-387-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802082165104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker