Provider Demographics
NPI:1790127314
Name:MATTENS, SOFIE
Entity Type:Individual
Prefix:MRS
First Name:SOFIE
Middle Name:
Last Name:MATTENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 INDUSTRY RD
Mailing Address - Street 2:
Mailing Address - City:INDUSTRY
Mailing Address - State:ME
Mailing Address - Zip Code:04938-4546
Mailing Address - Country:US
Mailing Address - Phone:207-491-8660
Mailing Address - Fax:
Practice Address - Street 1:1313 INDUSTRY RD
Practice Address - Street 2:
Practice Address - City:INDUSTRY
Practice Address - State:ME
Practice Address - Zip Code:04938-4546
Practice Address - Country:US
Practice Address - Phone:207-491-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC156261041C0700X
MEMC142391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical