Provider Demographics
NPI:1992193387
Name:DEBORAH M. MATHIS LCSW
Entity Type:Organization
Organization Name:DEBORAH M. MATHIS LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CSSW, LCSW
Authorized Official - Phone:609-501-5910
Mailing Address - Street 1:108 W MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-1424
Mailing Address - Country:US
Mailing Address - Phone:609-501-5910
Mailing Address - Fax:310-348-0201
Practice Address - Street 1:108 W MERCHANT ST
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1424
Practice Address - Country:US
Practice Address - Phone:609-501-5910
Practice Address - Fax:856-546-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05730300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty