Healthcare Provider Details

I. General information

NPI: 1497676191
Provider Name (Legal Business Name): JEFFREY MATHIAS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 CHURCH ST
PHELPS NY
14532-1139
US

IV. Provider business mailing address

52 CHURCH ST
PHELPS NY
14532-1139
US

V. Phone/Fax

Practice location:
  • Phone: 607-399-1862
  • Fax:
Mailing address:
  • Phone: 607-399-1862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number119817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: