Provider Demographics
NPI:1447361738
Name:DEWEIN, MATTHEW G (MSW,LCSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:DEWEIN
Suffix:
Gender:M
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 NW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-0716
Mailing Address - Country:US
Mailing Address - Phone:386-961-2218
Mailing Address - Fax:
Practice Address - Street 1:4033 NW 60TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-0716
Practice Address - Country:US
Practice Address - Phone:386-961-2218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 62071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical