Healthcare Provider Details

I. General information

NPI: 1730385725
Provider Name (Legal Business Name): GINA MATTHEWS BA, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CENTER ST
MIDDLETOWN NY
10940-5704
US

IV. Provider business mailing address

21 CENTER ST
MIDDLETOWN NY
10940-5704
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-7675
  • Fax: 845-343-2501
Mailing address:
  • Phone: 845-343-7675
  • Fax: 845-343-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: