Provider Demographics
NPI:1790825941
Name:GARNETT, MATTHEW MCKINNEY (MS,CAC,LADC,LPC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:MCKINNEY
Last Name:GARNETT
Suffix:
Gender:M
Credentials:MS,CAC,LADC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1040
Mailing Address - Country:US
Mailing Address - Phone:203-981-5459
Mailing Address - Fax:
Practice Address - Street 1:17 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1040
Practice Address - Country:US
Practice Address - Phone:203-981-5459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000745101YA0400X
CT001424101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional