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General NPI Number Information
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NPI Number | 1750983201
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Entity Type | Individual
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Provider Name | MATTHEW HEINTZ LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 400 5TH ST
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City | ELMONT
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State | NY
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Zip | 11003-2831
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Country | US
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Telephone | 631-240-3172
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Fax |
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Provider Business Mailing Address
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Address Line | 1399 HEMPSTEAD TPKE
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City | ELMONT
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State | NY
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Zip | 11003-2404
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Country | US
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Telephone | 631-240-3172
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 110048
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 097200
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License Number State | NY
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