Provider Demographics
NPI:1801340559
Name:MATHEW, JOMINI
Entity type:Individual
Prefix:
First Name:JOMINI
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OGDEN PL
Mailing Address - Street 2:FL 3
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-1913
Mailing Address - Country:US
Mailing Address - Phone:845-300-2423
Mailing Address - Fax:
Practice Address - Street 1:15 OGDEN PL
Practice Address - Street 2:FL 3
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1913
Practice Address - Country:US
Practice Address - Phone:845-300-2423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY637355737104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker