Provider Demographics
NPI:1629197801
Name:HAYDEN, MATTHEW JOHN (MA, LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JOHN
Last Name:HAYDEN
Suffix:
Gender:M
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60487
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-0487
Mailing Address - Country:US
Mailing Address - Phone:773-508-8885
Mailing Address - Fax:773-508-2740
Practice Address - Street 1:1052 W LOYOLA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-5206
Practice Address - Country:US
Practice Address - Phone:773-508-8885
Practice Address - Fax:773-508-2740
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2010-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490123961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical