Provider Demographics
NPI:1477307445
Name:KINSEY, MATTHEW (LMSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KINSEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:SALCEDO-KINSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:4516 30TH AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1279
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1115 BROADWAY FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3452
Practice Address - Country:US
Practice Address - Phone:917-722-2392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122285104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker