Provider Demographics
NPI:1023220282
Name:MATTA, GILBERTO (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:GILBERTO
Middle Name:
Last Name:MATTA
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 WINTHROP STREET
Mailing Address - Street 2:KINGS COUNTY HOSPITAL CTR, BEHAVIORAL HEALTH 'R' BLDG
Mailing Address - City:BROOKLYN,
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-245-8807
Mailing Address - Fax:718-245-2416
Practice Address - Street 1:410 WINTHROP STREET
Practice Address - Street 2:KINGS COUNTY HOSPITAL CTR, BEHAVIORAL HEALTH 'R' BLDG
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-245-8807
Practice Address - Fax:718-245-2416
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR024949-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical