Provider Demographics
NPI:1609051648
Name:MATHIEU, MARIE ANTOINE (MSW)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ANTOINE
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 LAMBERTON DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3414
Mailing Address - Country:US
Mailing Address - Phone:301-754-1102
Mailing Address - Fax:301-754-1690
Practice Address - Street 1:1398 LAMBERTON DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3414
Practice Address - Country:US
Practice Address - Phone:301-754-1102
Practice Address - Fax:301-754-1690
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089744104100000X
MD168511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical