Provider Demographics
NPI:1427019140
Name:BOONE, MATTHEW S
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:BOONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CORNELL UNIVERSITY HEALTH SERVICES
Mailing Address - Street 2:HO PLAZA
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14853-3101
Mailing Address - Country:US
Mailing Address - Phone:607-255-6946
Mailing Address - Fax:607-254-3503
Practice Address - Street 1:CORNELL UNIVERSITY HEALTH SERVICES
Practice Address - Street 2:HO PLAZA
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14853-3101
Practice Address - Country:US
Practice Address - Phone:607-255-6946
Practice Address - Fax:607-254-3503
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065439104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker