Provider Demographics
NPI:1669613766
Name:WHALEY, MATT E (LCSW)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:E
Last Name:WHALEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:WHALEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:130 5TH AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4306
Mailing Address - Country:US
Mailing Address - Phone:646-234-6515
Mailing Address - Fax:212-807-0706
Practice Address - Street 1:130 5TH AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4306
Practice Address - Country:US
Practice Address - Phone:646-234-6515
Practice Address - Fax:212-807-0706
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051663-11041C0700X
NJ44SC052859001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical