Provider Demographics
NPI:1487832564
Name:MATTHEWS, DOLORES JANE (MA)
Entity Type:Individual
Prefix:MS
First Name:DOLORES
Middle Name:JANE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:D
Other - Middle Name:JANE
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:23 4TH STREET SE
Mailing Address - Street 2:#202
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1090
Mailing Address - Country:US
Mailing Address - Phone:612-379-8050
Mailing Address - Fax:612-379-8069
Practice Address - Street 1:23 4TH STREET SE
Practice Address - Street 2:#202
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1090
Practice Address - Country:US
Practice Address - Phone:612-379-8050
Practice Address - Fax:612-379-8069
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2240103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
10946MAOtherBCBS
1581490OtherMEDICA