Provider Demographics
NPI:1972985877
Name:MATHISON, EVA
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:MATHISON
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 1:211 LOWER ST APT B8
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:MO
Mailing Address - Zip Code:63332-1743
Mailing Address - Country:US
Mailing Address - Phone:860-395-7904
Mailing Address - Fax:
Practice Address - Street 1:948 N LOGAN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-5704
Practice Address - Country:US
Practice Address - Phone:860-395-7904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099270741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical