Provider Demographics
NPI:1851759682
Name:MATHE, LAURICE
Entity Type:Individual
Prefix:
First Name:LAURICE
Middle Name:
Last Name:MATHE
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 1:6912 WOODSTREAM TURN
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2147
Mailing Address - Country:US
Mailing Address - Phone:240-478-4824
Mailing Address - Fax:
Practice Address - Street 1:6912 WOODSTREAM TURN
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2147
Practice Address - Country:US
Practice Address - Phone:240-478-4824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
DCHHA11716374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide