Provider Demographics
NPI:1518354984
Name:DINER, MATTHEW THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:DINER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:MR
Other - First Name:MATTHEW
Other - Middle Name:THOMAS
Other - Last Name:DINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, PHD
Mailing Address - Street 1:727 N BROADWAY STE A2
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2348
Mailing Address - Country:US
Mailing Address - Phone:917-267-8359
Mailing Address - Fax:
Practice Address - Street 1:727 N BROADWAY STE A2
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2348
Practice Address - Country:US
Practice Address - Phone:917-267-8359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0857281041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical