Provider Demographics
NPI:1528195385
Name:MATTSON, MARIE A (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:A
Last Name:MATTSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23348 DEER FORK TRL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:MI
Mailing Address - Zip Code:49709-9676
Mailing Address - Country:US
Mailing Address - Phone:989-356-2161
Mailing Address - Fax:
Practice Address - Street 1:400 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1434
Practice Address - Country:US
Practice Address - Phone:989-356-2161
Practice Address - Fax:989-354-5898
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010857891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801085789OtherSTATE OF MI LICENSE #