Provider Demographics
NPI:1043376502
Name:WOFSY, MATTHEW STEVEN I (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:STEVEN
Last Name:WOFSY
Suffix:I
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6738 108TH ST APT C47
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2370
Mailing Address - Country:US
Mailing Address - Phone:646-515-7688
Mailing Address - Fax:
Practice Address - Street 1:6812 YELLOWSTONE BLVD STE AA2
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3268
Practice Address - Country:US
Practice Address - Phone:646-265-1668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049327-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02386381Medicaid