Provider Demographics
NPI:1730385725
Name:MATTHEWS, GINA (BA, CASAC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:BA, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5704
Mailing Address - Country:US
Mailing Address - Phone:845-343-7675
Mailing Address - Fax:845-343-2501
Practice Address - Street 1:21 CENTER ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-5704
Practice Address - Country:US
Practice Address - Phone:845-343-7675
Practice Address - Fax:845-343-2501
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)