Provider Demographics
NPI:1801688767
Name:MATHESON, MEGAN KATHRYN (LMSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:KATHRYN
Last Name:MATHESON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:KATHRYN
Other - Last Name:MCCULLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 US OVAL STE 218
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12903-5902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2155 ROUTE 22B
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962-3417
Practice Address - Country:US
Practice Address - Phone:518-563-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121349-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker