MEDICARE: MATTHEW JAMES KRIEGER 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	128419	MA
2	104100000X	Social Worker	110540	NY
3	1041C0700X	Clinical Social Worker	102459	NY

General Provider Information

NPI Number	:	1417676958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW JAMES KRIEGER LCSW

Provider Business Mailing Address
First Line	:	138 TARGEE ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2067
Country	:	US
Telephone Number	:	646-397-3826
Fax Number	:

Provider Business Practice Location Address
First Line	:	138 TARGEE ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2067
Country	:	US
Telephone Number	:	646-397-3826
Fax Number	:

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

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	03/24/2026

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