Provider Demographics
NPI:1750051686
Name:MCKIE, MATTHEW (LICSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MCKIE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BRATTLE ST APT 12
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4324
Mailing Address - Country:US
Mailing Address - Phone:678-459-4104
Mailing Address - Fax:
Practice Address - Street 1:17 BRATTLE ST APT 12
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4324
Practice Address - Country:US
Practice Address - Phone:678-459-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1254281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical