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Individual
KRISTIN MARIE MATHES
Active
Individual
KRISTIN MARIE MATHES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
NULL
1041C0700X
Clinical Social Worker
Primary
L10773
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500737558
—
OR
Enumeration date
12/13/2017
Last updated
10/26/2021
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