Provider Demographics
NPI:1518979350
Name:MCMATH, WILLIAM THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:MCMATH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:THOMAS
Other - Last Name:MCMATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:150 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2835
Mailing Address - Country:US
Mailing Address - Phone:631-751-5699
Mailing Address - Fax:631-751-5699
Practice Address - Street 1:150 MAIN ST
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2835
Practice Address - Country:US
Practice Address - Phone:631-751-5699
Practice Address - Fax:631-751-5699
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011069103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01799004Medicaid