National Provider Identifier
Ivan A Matthew Jr., LCSW
Ivan A Matthew Jr., LCSW is listed in the NPPES registry with a primary specialty of Clinical Social Worker in Rochester, NY and a listed phone number of (585) 576-4830.
Profile Overview
- NPI
- 1245977768
- Provider Type
- Individual
- Primary Specialty
- Clinical Social Worker
- Enumeration Date
- May 16, 2022
- Last Updated
- May 16, 2022
Practice Location
- 223 Mystic Ln
- Rochester, NY 14623-5448
Phone: (585) 576-4830
Mailing Address
- 223 Mystic Lane
- Rochester, NY 14623-5448
Specialties
- Clinical Social Worker (1041C0700X)
Full Record
- NPI
- 1245977768
- Entity Type
- Individual
- Last Name
- Matthew
- First Name
- Ivan
- Middle Name
- A
- Name Suffix
- Jr.
- Credential
- LCSW
- Mailing Street Address
- 223 Mystic Lane
- Mailing City
- Rochester
- Mailing State
- NY
- Mailing ZIP Code
- 14623-5448
- Mailing Country
- US
- Mailing Phone
- (585) 576-4830
- Practice Street Address
- 223 Mystic Ln
- Practice City
- Rochester
- Practice State
- NY
- Practice ZIP Code
- 14623-5448
- Practice Country
- US
- Practice Phone
- (585) 576-4830
- Enumeration Date
- May 16, 2022
- Last Updated
- May 16, 2022
- Sex
- Male
- Sole Proprietor
- Yes
- Certification Date
- May 16, 2022
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Clinical Social Worker (1041C0700X)