Provider Demographics
NPI:1073765111
Name:MCKAY, MATTHEW J (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:MCKAY
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 6TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-1839
Mailing Address - Country:US
Mailing Address - Phone:507-287-2010
Mailing Address - Fax:507-287-7805
Practice Address - Street 1:1110 6TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-1839
Practice Address - Country:US
Practice Address - Phone:507-287-2010
Practice Address - Fax:507-287-7805
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN132101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical