Provider Demographics
NPI:1710435847
Name:MATHEIS, LATOYA MAKIA MOTTON (LICSW)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:MAKIA MOTTON
Last Name:MATHEIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GIESESTRASSE 3
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:HAMBURG
Mailing Address - Zip Code:22607
Mailing Address - Country:DE
Mailing Address - Phone:049174-319-0577
Mailing Address - Fax:
Practice Address - Street 1:KRONPRINZENSTRASSE 54
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:HAMBURG
Practice Address - Zip Code:22587
Practice Address - Country:DE
Practice Address - Phone:049406-009-2829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1194551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical