Provider Demographics
NPI:1497179188
Name:ORPHANIDES, MATTHEW (LMSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ORPHANIDES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5341
Mailing Address - Country:US
Mailing Address - Phone:731-642-0521
Mailing Address - Fax:731-642-1010
Practice Address - Street 1:408 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5341
Practice Address - Country:US
Practice Address - Phone:731-642-0521
Practice Address - Fax:731-642-1010
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000071511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical