Provider Demographics
NPI:1558730226
Name:MATZKOWITZ, HEATHER
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MATZKOWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E 29TH ST
Mailing Address - Street 2:APT 26D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8173
Mailing Address - Country:US
Mailing Address - Phone:727-692-7488
Mailing Address - Fax:
Practice Address - Street 1:155 E 29TH ST
Practice Address - Street 2:APT 26D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8173
Practice Address - Country:US
Practice Address - Phone:727-692-7488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical