Provider Demographics
NPI:1275018640
Name:AMADOR, MATTHEW SCOTT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:SCOTT
Last Name:AMADOR
Suffix:
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 1:5650 N SHERIDAN RD APT 17B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4829
Mailing Address - Country:US
Mailing Address - Phone:773-263-5702
Mailing Address - Fax:
Practice Address - Street 1:5650 N SHERIDAN RD APT 17B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4829
Practice Address - Country:US
Practice Address - Phone:773-263-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0221971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical