Provider Demographics
NPI:1861472276
Name:DOWLING, MATTHEW RONALD (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:RONALD
Last Name:DOWLING
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 EDEN AVE
Mailing Address - Street 2:STE. 108
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436
Mailing Address - Country:US
Mailing Address - Phone:612-360-3843
Mailing Address - Fax:952-929-4581
Practice Address - Street 1:5100 EDEN AVE
Practice Address - Street 2:STE. 108
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436
Practice Address - Country:US
Practice Address - Phone:612-360-3843
Practice Address - Fax:952-929-4581
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN146021041C0700X
14602104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1861472276Medicaid
800001391Medicare ID - Type Unspecified