Provider Demographics
NPI:1477677383
Name:MATSUYOSHI, JUN (LCSW)
Entity Type:Individual
Prefix:
First Name:JUN
Middle Name:
Last Name:MATSUYOSHI
Suffix:
Gender:F
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 5TH AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4337
Mailing Address - Country:US
Mailing Address - Phone:212-348-6249
Mailing Address - Fax:
Practice Address - Street 1:29 5TH AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4337
Practice Address - Country:US
Practice Address - Phone:212-348-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO38823-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical