Provider Demographics
NPI:1477939270
Name:EASLEY, MATTHEW BENNETT
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:BENNETT
Last Name:EASLEY
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 1:11 SALCOMBE ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2045
Mailing Address - Country:US
Mailing Address - Phone:732-245-3220
Mailing Address - Fax:
Practice Address - Street 1:42 DIAUTO DR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4510
Practice Address - Country:US
Practice Address - Phone:781-885-7252
Practice Address - Fax:781-885-7256
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor