Provider Demographics
NPI:1366576910
Name:MATTHEWS-NILSEN, PEGGY (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:
Last Name:MATTHEWS-NILSEN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4622 WOODFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4044
Mailing Address - Country:US
Mailing Address - Phone:301-571-5191
Mailing Address - Fax:
Practice Address - Street 1:4622 WOODFIELD RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4044
Practice Address - Country:US
Practice Address - Phone:301-571-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD052631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical