Provider Demographics
NPI:1902962061
Name:ENGEL, PAUL MATTHEW (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MATTHEW
Last Name:ENGEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 ROBBYN LN
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5959
Mailing Address - Country:US
Mailing Address - Phone:646-358-0504
Mailing Address - Fax:718-463-8937
Practice Address - Street 1:4343 BOWNE ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3039
Practice Address - Country:US
Practice Address - Phone:718-461-6393
Practice Address - Fax:718-463-8937
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0279551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01758992Medicaid
NY748079Medicare ID - Type Unspecified
NYN42R81Medicare ID - Type Unspecified
NY00026IMedicare ID - Type Unspecified
NY01758992Medicaid