Provider Demographics
NPI:1538837406
Name:KASTELIC, MATTHEW (LMHC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KASTELIC
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HARVESTER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-3300
Mailing Address - Country:US
Mailing Address - Phone:585-252-0030
Mailing Address - Fax:
Practice Address - Street 1:26 HARVESTER AVE STE 104
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3300
Practice Address - Country:US
Practice Address - Phone:585-252-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011454-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health