Provider Demographics
NPI:1558711838
Name:NYSSA MATSON-KEATS, LICSW
Entity Type:Organization
Organization Name:NYSSA MATSON-KEATS, LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NYSSAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATSON-KEATS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:857-998-0731
Mailing Address - Street 1:85 CUSHING ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4581
Mailing Address - Country:US
Mailing Address - Phone:857-998-0731
Mailing Address - Fax:
Practice Address - Street 1:120 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7432
Practice Address - Country:US
Practice Address - Phone:857-998-0731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111996251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health