Provider Demographics
NPI:1083049621
Name:MATHIEZ, CRISTIN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:CRISTIN
Middle Name:
Last Name:MATHIEZ
Suffix:
Gender:F
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 1:299 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1703
Mailing Address - Country:US
Mailing Address - Phone:844-926-4357
Mailing Address - Fax:
Practice Address - Street 1:299 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1703
Practice Address - Country:US
Practice Address - Phone:844-926-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077079-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical