Provider Demographics
NPI:1508008475
Name:YEAZEL, MATTHEW (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:YEAZEL
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 BELLERIVE RD
Mailing Address - Street 2:UNIT 5B
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-4602
Mailing Address - Country:US
Mailing Address - Phone:410-757-0846
Mailing Address - Fax:410-757-0846
Practice Address - Street 1:580 BELLERIVE RD
Practice Address - Street 2:UNIT 5B
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-4602
Practice Address - Country:US
Practice Address - Phone:410-757-0846
Practice Address - Fax:410-757-0846
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical