Provider Demographics
NPI:1346706074
Name:MACAULAY, MATTHEW REED (LICSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:REED
Last Name:MACAULAY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 ELM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05257-9196
Mailing Address - Country:US
Mailing Address - Phone:908-705-6751
Mailing Address - Fax:
Practice Address - Street 1:5 BANK ST
Practice Address - Street 2:
Practice Address - City:NORTH BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05257-9102
Practice Address - Country:US
Practice Address - Phone:908-705-6751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-01341761041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical