MEDICARE: MISS ALLISON PAIGE MATOS LCSW

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	44SC05251200	NJ

General Provider Information

NPI Number	:	1417159856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ALLISON PAIGE MATOS LCSW

Provider Business Mailing Address
First Line	:	65 CORTLAND PL
Second Line	:
City	:	CLIFFSIDE PARK
State	:	NJ
Zip	:	07010-2820
Country	:	US
Telephone Number	:	201-943-7944
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 KINDERKAMACK RD
Second Line	:	SUITE 102
City	:	ORADELL
State	:	NJ
Zip	:	07649-2259
Country	:	US
Telephone Number	:	845-893-4500
Fax Number	:

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	03/07/2010

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