Basic Information
| Provider Information | |||||||||
| NPI: | 1043302003 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATENS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | BERNARD | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 EAST WOODROW WILSON DRIVE | ||||||||
| Address2: | DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER (586/122) | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392165591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013624471 | ||||||||
| FaxNumber: | 6013684093 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 E. WOODROW WILSON DR. | ||||||||
| Address2: | DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER (586/122 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392165591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013624471 | ||||||||
| FaxNumber: | 6013684093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C0732 | MS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.