Healthcare Provider Details

I. General information

NPI: 1083560163
Provider Name (Legal Business Name): MATTHEW RAYMOND CLEMENTS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 GREAT PLAIN AVE # 296
NEEDHAM MA
02492-3031
US

IV. Provider business mailing address

38 TRASK RD
PEABODY MA
01960-2740
US

V. Phone/Fax

Practice location:
  • Phone: 401-426-4505
  • Fax: 617-663-6484
Mailing address:
  • Phone: 617-329-1663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10005702
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: