Provider Demographics
NPI:1821707266
Name:IHNKEN, MATTHEW C (LSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:IHNKEN
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 RAVENWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2205
Mailing Address - Country:US
Mailing Address - Phone:609-661-8491
Mailing Address - Fax:
Practice Address - Street 1:613 HOPE RD
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1278
Practice Address - Country:US
Practice Address - Phone:732-544-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-21-162956106S00000X
NJ44SL06871500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician