Provider Demographics
NPI:1225723059
Name:MATHEWS, KADIE (LCSW)
Entity type:Individual
Prefix:
First Name:KADIE
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KADIE
Other - Middle Name:
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:OOLITIC
Mailing Address - State:IN
Mailing Address - Zip Code:47451-9775
Mailing Address - Country:US
Mailing Address - Phone:812-545-9336
Mailing Address - Fax:
Practice Address - Street 1:1115 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:OOLITIC
Practice Address - State:IN
Practice Address - Zip Code:47451-9775
Practice Address - Country:US
Practice Address - Phone:812-545-9336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010307A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical