Provider Demographics
NPI:1851977474
Name:CHRYSTAL, MATT (MA, LPC, NCC, ACS)
Entity Type:Individual
Prefix:MR
First Name:MATT
Middle Name:
Last Name:CHRYSTAL
Suffix:
Gender:M
Credentials:MA, LPC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SALTER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1610
Mailing Address - Country:US
Mailing Address - Phone:973-489-2969
Mailing Address - Fax:
Practice Address - Street 1:25B HANOVER RD
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1442
Practice Address - Country:US
Practice Address - Phone:973-489-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00455100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health