Provider Demographics
NPI:1437311669
Name:MATTHEWS, KIM (MSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FISKE PL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-3205
Mailing Address - Country:US
Mailing Address - Phone:914-664-0400
Mailing Address - Fax:914-664-0404
Practice Address - Street 1:10 FISKE PL
Practice Address - Street 2:SUITE 205
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3205
Practice Address - Country:US
Practice Address - Phone:914-664-0400
Practice Address - Fax:914-664-0404
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker