Provider Demographics
NPI:1902237480
Name:MATRESA WOODING LCSW PLLC
Entity Type:Organization
Organization Name:MATRESA WOODING LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:MATRESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-727-0014
Mailing Address - Street 1:7980 ANCHOR DR STE 100A
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8267
Mailing Address - Country:US
Mailing Address - Phone:409-727-0014
Mailing Address - Fax:409-727-0024
Practice Address - Street 1:7980 ANCHOR DR STE 100A
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8267
Practice Address - Country:US
Practice Address - Phone:409-727-0014
Practice Address - Fax:409-727-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty