Provider Demographics
NPI:1013892314
Name:SMITH, MATTHEW J
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:TILLSON
Mailing Address - State:NY
Mailing Address - Zip Code:12486-1219
Mailing Address - Country:US
Mailing Address - Phone:845-663-3118
Mailing Address - Fax:845-658-3558
Practice Address - Street 1:23 SPRING ST
Practice Address - Street 2:
Practice Address - City:TILLSON
Practice Address - State:NY
Practice Address - Zip Code:12486-1219
Practice Address - Country:US
Practice Address - Phone:845-663-3118
Practice Address - Fax:845-658-3558
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health