Provider Demographics
NPI:1467649343
Name:MATHY, ROBIN MICHELE (MSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:MICHELE
Last Name:MATHY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:MICHELLE
Other - Last Name:MATHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:1841 MADORA AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-3057
Mailing Address - Country:US
Mailing Address - Phone:307-358-2846
Mailing Address - Fax:307-358-5329
Practice Address - Street 1:344 N CENTRAL AVE APT 9
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-5952
Practice Address - Country:US
Practice Address - Phone:154-169-0120
Practice Address - Fax:307-358-5329
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPAT-025101YA0400X
WYPCSW-2641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)