Active NPI
Matthew Yeazel, LCSW-C
- Clinical Social Worker
- Annapolis, MD
National Provider Identifier
1508008475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 10058
- Practice address
- 580 Bellerive Rd
Unit 5B
Annapolis, MD 21409-4602 - Phone
- (410) 757-0846
- Fax
- (410) 757-0846
- NPI assigned
- Mar 24, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 10058 | MD | Primary |
Addresses
Primary practice location
580 Bellerive Rd
Unit 5B
Annapolis, MD 21409-4602
Mailing address
580 Bellerive Rd
Unit 5B
Annapolis, MD 21409-4602
Phone (410) 757-0846
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10058 | MD | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1237852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237852800000",
"number": "1508008475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "580 BELLERIVE RD",
"address_2": "UNIT 5B",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214094602",
"telephone_number": "410-757-0846",
"fax_number": "410-757-0846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "580 BELLERIVE RD",
"address_2": "UNIT 5B",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214094602",
"telephone_number": "410-757-0846",
"fax_number": "410-757-0846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YEAZEL",
"first_name": "MATTHEW",
"credential": "LCSW-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-03-24",
"last_updated": "2009-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "10058",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Annapolis, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.