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General NPI Number Information
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NPI Number | 1174896021
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Entity Type | Organization
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Legal Business Name | MATTHEW D GEE, LCSW, PHD, LLC
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 363 ROUTE 111 SUITE 103
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City | SMITHTOWN
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State | NY
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Zip | 11787-4756
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Country | US
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Telephone | 631-335-8744
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Fax | 631-265-3205
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Provider Business Mailing Address
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Address Line | 363 ROUTE 111 SUITE 103
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City | SMITHTOWN
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State | NY
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Zip | 11787-4756
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Country | US
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Telephone | 631-335-8744
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Fax | 631-265-3205
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MATTHEW DOUGLAS GEE
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Credential | LCSW
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Telephone | 631-335-8744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | R051398-1
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License Number State | NY
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