Healthcare Provider Details

I. General information

NPI: 1932440179
Provider Name (Legal Business Name): MATTHEW DANTE COSENTINO LMHC-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PARK LN
MASSAPEQUA NY
11758-4305
US

IV. Provider business mailing address

50 PARK LN
MASSAPEQUA NY
11758-4305
US

V. Phone/Fax

Practice location:
  • Phone: 716-566-8769
  • Fax:
Mailing address:
  • Phone: 716-566-8769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number013260
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: