Provider Demographics
NPI:1295941995
Name:MATHER, RATHBUN FULLER JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:RATHBUN
Middle Name:FULLER
Last Name:MATHER
Suffix:JR
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 1:80 E. 11TH STREET
Mailing Address - Street 2:SUITE 510
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:718-638-0192
Mailing Address - Fax:718-638-5039
Practice Address - Street 1:80 E 11TH ST
Practice Address - Street 2:SUITE 510
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:718-638-0192
Practice Address - Fax:718-638-5039
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0379681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical