Healthcare Provider Details

I. General information

NPI: 1568855385
Provider Name (Legal Business Name): JEFFREY EDWARD MATYAS SR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 VAUXHALL EXT, SUITE 207
WATERFORD CT
06385
US

IV. Provider business mailing address

6 FILOSI RD
EAST LYME CT
06333-1103
US

V. Phone/Fax

Practice location:
  • Phone: 860-912-3743
  • Fax:
Mailing address:
  • Phone: 860-912-3743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9119
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number001111
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: