Juanita C Matlock, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.022186 Issued in IL

Practice address

4321 Fir St
East Chicago, IN 46312

Phone

(219) 392-7469

NPI assigned

Mar 11, 2021

Sex

Female

Sole proprietor

Yes

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

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  IN

  Medicare reassignment NPD

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

{
    "created_epoch": "1615420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1144805151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4321 FIR ST",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "46312",
            "telephone_number": "219-392-7469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4321 FIR ST",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "46312",
            "telephone_number": "219-392-7469"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "919 E 28th Ave",
            "address_purpose": "LOCATION",
            "city": "Lake Station",
            "state": "IN",
            "postal_code": "464051509",
            "country_code": "US",
            "telephone_number": "219-781-6231",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATLOCK",
        "first_name": "JUANITA",
        "middle_name": "C",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-11",
        "last_updated": "2024-02-22",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.022186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Major Hospital
• Mangahas Medical Care, P.C.
• Jason Mantel
• Erin Mantis, HSPP
• Robert Scott Martin, DC
• Renea Maxfield
• Melinda McKeague, LMHC
• Michael Christopher McLain, BA
• Christiana Elise McLean, FNP-BC
• Angelica Seferina Medina

• Clinical Social Worker in East Chicago, IN
• Providers in East Chicago, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.