Provider Demographics
NPI:1922443035
Name:SIEGEL, MATTHEW C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:C
Last Name:SIEGEL
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 1:261 SCHENECTADY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4026
Mailing Address - Country:US
Mailing Address - Phone:718-372-0450
Mailing Address - Fax:718-372-0683
Practice Address - Street 1:261 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4026
Practice Address - Country:US
Practice Address - Phone:718-372-0450
Practice Address - Fax:718-372-0683
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0850191041C0700X
NY08418L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical