Provider Demographics
NPI:1598034373
Name:MATSON, THERESA JOY (LSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:JOY
Last Name:MATSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1326
Mailing Address - Country:US
Mailing Address - Phone:724-331-3217
Mailing Address - Fax:
Practice Address - Street 1:501 N SAINT CLAIR ST
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1326
Practice Address - Country:US
Practice Address - Phone:724-331-3217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW013566L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker