Provider Demographics
NPI:1932513868
Name:MATONTI, BRIAN (CASAC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MATONTI
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ALLEGHENY DR E
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2837
Mailing Address - Country:US
Mailing Address - Phone:631-291-7074
Mailing Address - Fax:
Practice Address - Street 1:37 ALLEGHENY DR E
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2837
Practice Address - Country:US
Practice Address - Phone:631-291-7074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19546101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)