Provider Demographics
NPI:1407349061
Name:KAY, MATTHEW L (LSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:L
Last Name:KAY
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19885 DETROIT RD # 156
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1815
Mailing Address - Country:US
Mailing Address - Phone:216-563-1661
Mailing Address - Fax:
Practice Address - Street 1:20575 CENTER RIDGE RD STE 318
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3422
Practice Address - Country:US
Practice Address - Phone:216-563-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.20051961041C0700X
OHS.1800416-TRNE104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker