Provider Demographics
NPI:1821497678
Name:SHIRLEY MATTFELD LCSW LLC
Entity Type:Organization
Organization Name:SHIRLEY MATTFELD LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-852-3358
Mailing Address - Street 1:47 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1505
Mailing Address - Country:US
Mailing Address - Phone:860-852-3358
Mailing Address - Fax:
Practice Address - Street 1:85 BROAD ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3236
Practice Address - Country:US
Practice Address - Phone:860-852-3358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0062281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty