MEDICARE: MATTHEW J PRITIKIN LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SL07289500	NJ

General Provider Information

NPI Number	:	1043185630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW J PRITIKIN LSW

Provider Business Mailing Address
First Line	:	29 SANDERSON AVE
Second Line	:
City	:	WEST CALDWELL
State	:	NJ
Zip	:	07006-7974
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	96 MILLBURN AVE
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1944
Country	:	US
Telephone Number	:	201-632-5554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	04/03/2026

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