Provider Demographics
NPI:1477123941
Name:MATHIS, ASHA (MSW)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:MATHIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 NIAGARA ST STE 142
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1108
Mailing Address - Country:US
Mailing Address - Phone:716-359-1550
Mailing Address - Fax:
Practice Address - Street 1:564 NIAGARA ST STE 142
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1108
Practice Address - Country:US
Practice Address - Phone:716-359-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker