Provider Demographics
NPI:1871042531
Name:MCDAVID, MATTHEW COLLINS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:COLLINS
Last Name:MCDAVID
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 HILL ST STE 51
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5316
Mailing Address - Country:US
Mailing Address - Phone:631-904-0844
Mailing Address - Fax:
Practice Address - Street 1:53 HILL ST STE 51
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5316
Practice Address - Country:US
Practice Address - Phone:631-904-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094806-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty