Provider Demographics
NPI:1417219304
Name:VONUNWERTH, MATTHEW FREDERICK (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:FREDERICK
Last Name:VONUNWERTH
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:FREDERICK
Other - Last Name:VON UNWERTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:529 E 85TH ST
Mailing Address - Street 2:APARTMENT 3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7441
Mailing Address - Country:US
Mailing Address - Phone:917-535-4797
Mailing Address - Fax:
Practice Address - Street 1:333 W 56TH ST APT 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3734
Practice Address - Country:US
Practice Address - Phone:917-535-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT098.0088779102L00000X
NY000885102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst