Provider Demographics
NPI:1114532983
Name:CRONIN, MATTHEW W (MA, LPCA, LMHCA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:CRONIN
Suffix:
Gender:M
Credentials:MA, LPCA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 RIVER RD N STE B
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5324
Mailing Address - Country:US
Mailing Address - Phone:360-356-1921
Mailing Address - Fax:
Practice Address - Street 1:2830 NE FLANDERS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3257
Practice Address - Country:US
Practice Address - Phone:360-356-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
WAMC61256645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program