Provider Demographics
NPI:1629254206
Name:MATHEWS, JOHN DOUGLAS (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DOUGLAS
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W 73RD ST
Mailing Address - Street 2:LOBBY SUITE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3006
Mailing Address - Country:US
Mailing Address - Phone:212-362-4925
Mailing Address - Fax:212-865-7167
Practice Address - Street 1:170 W 73RD ST
Practice Address - Street 2:LOBBY SUITE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3006
Practice Address - Country:US
Practice Address - Phone:212-362-4925
Practice Address - Fax:212-865-7167
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical