Chanel Gray Mateo, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

Q1-0001795 Issued in DE

Practice address

4102 Pinion Dr
Usaf Academy, CO 80840-2502

Phone

(719) 333-5270

NPI assigned

Dec 12, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1114432234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025438",
            "telephone_number": "315-772-3138",
            "fax_number": "315-772-6229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4102 PINION DR",
            "city": "USAF ACADEMY",
            "state": "CO",
            "postal_code": "808402502",
            "telephone_number": "719-333-5270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATEO",
        "first_name": "CHANEL",
        "middle_name": "GRAY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-12",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DE",
            "license": "Q1-0001795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William F Mann II, MD, MPH
• Nikhil Manocha, DMD
• Erik Marsh
• Sarah Elizabeth Martin, RN, CNM, WHCNP, DNP
• Nabih Masri, DPM
• Leslie Sue Mattorano, PHARMD
• Kendra Maurer, RD
• Stephen Jad Mazurkivich, MD
• Mark Richard McDowell, RPH
• Gerald Thomas McGinty, DPT

• Clinical Social Worker in Usaf Academy, CO
• Providers in Usaf Academy, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.