Provider Demographics
NPI:1457374167
Name:KAWIAK, MATTHEW ANDREW (DMIN, LCSW)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ANDREW
Last Name:KAWIAK
Suffix:
Gender:M
Credentials:DMIN, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 PANORAMA TRAIL
Mailing Address - Street 2:BLDG 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625
Mailing Address - Country:US
Mailing Address - Phone:585-586-8650
Mailing Address - Fax:585-387-0516
Practice Address - Street 1:625 PANORAMA TRL
Practice Address - Street 2:BLDG 1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2404
Practice Address - Country:US
Practice Address - Phone:585-586-8650
Practice Address - Fax:585-387-0516
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038598-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR038598-1OtherLCSW
NYR038598-1OtherLCSW