Provider Demographics
NPI:1427536317
Name:MATOS, LEONEL LEVI (LCSW)
Entity Type:Individual
Prefix:
First Name:LEONEL
Middle Name:LEVI
Last Name:MATOS
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 1:29 STIMA AVE
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-1214
Mailing Address - Country:US
Mailing Address - Phone:732-824-2420
Mailing Address - Fax:
Practice Address - Street 1:29 STIMA AVE
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-1214
Practice Address - Country:US
Practice Address - Phone:732-824-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05801300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty