Provider Demographics
NPI:1497856876
Name:NUTT, MATTHEW J (LCSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:NUTT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 UNION ST STE C
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6100
Mailing Address - Country:US
Mailing Address - Phone:207-478-8645
Mailing Address - Fax:207-514-0726
Practice Address - Street 1:175 UNION ST STE C
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6100
Practice Address - Country:US
Practice Address - Phone:207-478-8645
Practice Address - Fax:207-514-0726
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LC77201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0080Medicare ID - Type Unspecified