Provider Demographics
NPI:1336389584
Name:WOODING, MATRESA LEA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MATRESA
Middle Name:LEA
Last Name:WOODING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7980 ANCHOR DR STE 100A
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8267
Mailing Address - Country:US
Mailing Address - Phone:409-727-0014
Mailing Address - Fax:409-727-0024
Practice Address - Street 1:7980 ANCHOR DR
Practice Address - Street 2:STE 100A
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8266
Practice Address - Country:US
Practice Address - Phone:409-781-7636
Practice Address - Fax:409-727-0024
Is Sole Proprietor?:No
Enumeration Date:2009-03-01
Last Update Date:2019-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146471041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB127770Medicare PIN