Provider Demographics
NPI:1487686648
Name:MATTISON, FAITH E (LCSW, MSSW)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:E
Last Name:MATTISON
Suffix:
Gender:F
Credentials:LCSW, MSSW
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:E
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:903 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2970
Mailing Address - Country:US
Mailing Address - Phone:608-756-5555
Mailing Address - Fax:608-756-0174
Practice Address - Street 1:903 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2970
Practice Address - Country:US
Practice Address - Phone:608-756-5555
Practice Address - Fax:608-756-0174
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6913123104100000X
WI6913-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIMATTIFAI-MOOtherMERCYCARE INSURANCE
WI1487686648OtherBCBSWI
WI1487686648Medicaid
WI1487686648OtherBCBSWI