Provider Demographics
NPI:1699837955
Name:WILLIAMS, MATTHEW EDWARD (MA, LPC, LCADC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:EDWARD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MA, LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-2012
Mailing Address - Country:US
Mailing Address - Phone:973-794-6401
Mailing Address - Fax:973-794-6404
Practice Address - Street 1:408 MAIN ST STE 1010C
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1768
Practice Address - Country:US
Practice Address - Phone:973-557-7500
Practice Address - Fax:973-794-6404
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00172900101YA0400X
NJ37PC00419400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ12216605OtherCAQH