Provider Demographics
NPI:1447692983
Name:MATES, SCOTT WILLIAM (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:WILLIAM
Last Name:MATES
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 1:1103 N HAMILTON ST
Mailing Address - Street 2:APT. H
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-1231
Mailing Address - Country:US
Mailing Address - Phone:910-612-8786
Mailing Address - Fax:
Practice Address - Street 1:3800 MEADOWDALE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-5750
Practice Address - Country:US
Practice Address - Phone:804-743-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040083091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical