Provider Demographics
NPI:1770125734
Name:STANIEWICZ, MATTHEW PAUL (LMSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PAUL
Last Name:STANIEWICZ
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COLUMBUS AVENUE
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1233
Mailing Address - Country:US
Mailing Address - Phone:203-503-3000
Mailing Address - Fax:203-503-3183
Practice Address - Street 1:121 WAKELEE AVENUE
Practice Address - Street 2:ACS
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1198
Practice Address - Country:US
Practice Address - Phone:203-503-3650
Practice Address - Fax:203-503-3659
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4954104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker