Provider Demographics
NPI:1679904262
Name:BARKER, MATEY (LCADC, LGSW)
Entity type:Individual
Prefix:
First Name:MATEY
Middle Name:
Last Name:BARKER
Suffix:
Gender:F
Credentials:LCADC, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 CRISFIELD HWY
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21871-3922
Mailing Address - Country:US
Mailing Address - Phone:443-523-1792
Mailing Address - Fax:410-651-3189
Practice Address - Street 1:7920 CRISFIELD HWY
Practice Address - Street 2:
Practice Address - City:WESTOVER
Practice Address - State:MD
Practice Address - Zip Code:21871-3922
Practice Address - Country:US
Practice Address - Phone:443-523-1792
Practice Address - Fax:410-651-3189
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA397101YA0400X
MDG10612104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)