Healthcare Provider Details

I. General information

NPI: 1295733699
Provider Name (Legal Business Name): MATTHEW ALAN KRIVOSHEY PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 PARK AVE SUITE 110#9
HUNTINGTON NY
11743-3976
US

IV. Provider business mailing address

20 ASHFORD LN
HUNTINGTON NY
11743-4874
US

V. Phone/Fax

Practice location:
  • Phone: 631-630-4620
  • Fax: 631-754-3654
Mailing address:
  • Phone: 631-630-4620
  • Fax: 631-754-3654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number014389
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number014389
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: