Provider Demographics
NPI:1265591028
Name:NEY-MATHEWS, MARY JEAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JEAN
Last Name:NEY-MATHEWS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:JEAN
Other - Last Name:NEY-MATHEWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-0005
Mailing Address - Country:US
Mailing Address - Phone:228-623-8994
Mailing Address - Fax:
Practice Address - Street 1:4836 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-2700
Practice Address - Country:US
Practice Address - Phone:228-363-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC6529101YM0800X
AL2370C101YM0800X
WVCPO3943775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health