Provider Demographics
NPI:1922482306
Name:MATE, PHYLLIS (LMSW)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:MATE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 OCEAN PKWY
Mailing Address - Street 2:APT 10B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7960
Mailing Address - Country:US
Mailing Address - Phone:718-373-5787
Mailing Address - Fax:
Practice Address - Street 1:41 E 11TH ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4602
Practice Address - Country:US
Practice Address - Phone:646-599-4008
Practice Address - Fax:212-477-2040
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0840981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical