Provider Demographics
NPI:1811262116
Name:FERREIRA, MATTHEW (MSW)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:FERREIRA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HOWE ST STE 4
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4620
Mailing Address - Country:US
Mailing Address - Phone:833-999-7662
Mailing Address - Fax:
Practice Address - Street 1:48 HOWE ST STE 4
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4620
Practice Address - Country:US
Practice Address - Phone:833-999-7662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
CT82070400001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTXGN9990876089OtherANTHEM
CT85-4047542OtherDEPARTMENT OF PUBLIC HEALTH