Provider Demographics
NPI:1245938521
Name:MATSON, MARIAH LYN (LMSW-CC, CADC)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:LYN
Last Name:MATSON
Suffix:
Gender:F
Credentials:LMSW-CC, CADC
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:LYN
Other - Last Name:DUFOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:235 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5943
Mailing Address - Country:US
Mailing Address - Phone:207-739-2644
Mailing Address - Fax:207-739-2467
Practice Address - Street 1:235 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5943
Practice Address - Country:US
Practice Address - Phone:207-739-2644
Practice Address - Fax:207-739-2467
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC8169101YA0400X
MEMC202241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)