Provider Demographics
NPI:1306825641
Name:JOST, MATTHEW A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:A
Last Name:JOST
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 1:55 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1648
Mailing Address - Country:US
Mailing Address - Phone:716-832-0089
Mailing Address - Fax:716-832-0089
Practice Address - Street 1:55 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1648
Practice Address - Country:US
Practice Address - Phone:716-832-0089
Practice Address - Fax:716-832-0089
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR044604-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000525293002OtherBLUE CROSS
NY743099456-01OtherPRISM HEALTH NETWORK
NY743099456-99OtherPRISM NETWORK-EAP
NY00026411301OtherUNIVERA
NYDD5814Medicare ID - Type Unspecified8803216776000
NY743099456-99OtherPRISM NETWORK-EAP