Provider Demographics
NPI:1275559965
Name:MATOS, JAVIER MILTON (LCSW)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:MILTON
Last Name:MATOS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JAVIER
Other - Middle Name:MILTON
Other - Last Name:MATOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6014 60TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-3410
Mailing Address - Country:US
Mailing Address - Phone:718-386-8527
Mailing Address - Fax:718-821-4499
Practice Address - Street 1:6014 60TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-3410
Practice Address - Country:US
Practice Address - Phone:718-366-6252
Practice Address - Fax:718-366-6253
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02209263Medicaid
NY04781Medicare ID - Type Unspecified