Provider Demographics
NPI:1811132590
Name:MATOS, EILEEN FRANCES (LCSW)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:FRANCES
Last Name:MATOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 E 69TH ST
Mailing Address - Street 2:12K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5643
Mailing Address - Country:US
Mailing Address - Phone:212-746-0516
Mailing Address - Fax:212-746-8458
Practice Address - Street 1:505 E 70TH ST
Practice Address - Street 2:FIFTH FLOOR RESIDENT GROUP PRACTICE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4872
Practice Address - Country:US
Practice Address - Phone:212-746-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73-024948106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist