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General NPI Number Information
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NPI Number | 1245889120
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Entity Type | Individual
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Provider Name | MATTHEW MCNALLY LPC
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Gender | Male
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 350 GROVE ST STE 206
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-2833
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Country | US
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Telephone | 908-393-2725
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Fax |
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Provider Business Mailing Address
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Address Line | 540 FARLEY AVE
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City | SCOTCH PLAINS
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State | NJ
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Zip | 07076-1634
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Country | US
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Telephone | 908-337-3871
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00670300
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License Number State | NJ
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