Provider Demographics
NPI:1407391790
Name:FREY, MATTHEW (LCSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:FREY
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 1:2203 STEINWAY ST
Mailing Address - Street 2:APT 2L
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1863
Mailing Address - Country:US
Mailing Address - Phone:845-659-5922
Mailing Address - Fax:
Practice Address - Street 1:2203 STEINWAY ST
Practice Address - Street 2:APT 2L
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1863
Practice Address - Country:US
Practice Address - Phone:845-659-5922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0836231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical