Provider Demographics
NPI:1740674324
Name:BELEVICH, MATTHEW (LCSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BELEVICH
Suffix:
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 1:681 CLARKSON AVE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2199
Mailing Address - Country:US
Mailing Address - Phone:718-221-7924
Mailing Address - Fax:
Practice Address - Street 1:681 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2199
Practice Address - Country:US
Practice Address - Phone:718-221-7924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092955104100000X
NY087329-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker