Provider Demographics
NPI:1184414534
Name:PENTKOWSKI, MATTHEW DAVID (LAADC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:PENTKOWSKI
Suffix:
Gender:M
Credentials:LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-1802
Mailing Address - Country:US
Mailing Address - Phone:949-698-8531
Mailing Address - Fax:
Practice Address - Street 1:336 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-1802
Practice Address - Country:US
Practice Address - Phone:949-698-8531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALR10290623101Y00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor