Provider Demographics
NPI:1205896784
Name:MATTHEWS, DAVID E (LCSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 KANE DR
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-2535
Mailing Address - Country:US
Mailing Address - Phone:618-988-8273
Mailing Address - Fax:
Practice Address - Street 1:109 LOU ANN DR
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3733
Practice Address - Country:US
Practice Address - Phone:618-988-1330
Practice Address - Fax:618-988-8321
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
K16185Medicare ID - Type Unspecified