Provider Demographics
NPI:1811594302
Name:ESTRADE, MATTHEW (MA, MBA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ESTRADE
Suffix:
Gender:M
Credentials:MA, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5056
Mailing Address - Country:US
Mailing Address - Phone:504-339-1757
Mailing Address - Fax:
Practice Address - Street 1:711 SILVERMINE RD
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4329
Practice Address - Country:US
Practice Address - Phone:314-888-5233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health