Provider Demographics
NPI:1245889120
Name:MCNALLY, MATTHEW (LPC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MCNALLY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 FARLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1634
Mailing Address - Country:US
Mailing Address - Phone:908-337-3871
Mailing Address - Fax:
Practice Address - Street 1:350 GROVE ST STE 206
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2833
Practice Address - Country:US
Practice Address - Phone:908-393-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00670300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional