Provider Demographics
NPI:1881844223
Name:REID, MATTHEW RYAN (LICSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:RYAN
Last Name:REID
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE
Mailing Address - State:MA
Mailing Address - Zip Code:02561-0109
Mailing Address - Country:US
Mailing Address - Phone:508-888-5005
Mailing Address - Fax:
Practice Address - Street 1:109 ADAMS STREET
Practice Address - Street 2:
Practice Address - City:SAGAMORE
Practice Address - State:MA
Practice Address - Zip Code:02561-0109
Practice Address - Country:US
Practice Address - Phone:508-888-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1166481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical