Provider Demographics
NPI:1477383925
Name:MATTHEW, JONATHAN (LSW)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:MATTHEW
Suffix:
Gender:U
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W ASPEN CT
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-0712
Mailing Address - Country:US
Mailing Address - Phone:847-830-1773
Mailing Address - Fax:
Practice Address - Street 1:3166 N LINCOLN AVE STE 400B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3174
Practice Address - Country:US
Practice Address - Phone:312-529-8415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.11384104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker