Provider Demographics
NPI:1881300903
Name:GERMOSO, MATT (CRPA)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:GERMOSO
Suffix:
Gender:M
Credentials:CRPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 PELTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1538
Mailing Address - Country:US
Mailing Address - Phone:347-216-2217
Mailing Address - Fax:
Practice Address - Street 1:392 SEGUINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3906
Practice Address - Country:US
Practice Address - Phone:718-226-2637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)