MEDICARE: MATTHEW KASTELIC LMHC

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	101YM0800X	Mental Health Counselor	011454-01	NY

General Provider Information

NPI Number	:	1538837406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW KASTELIC LMHC

Provider Business Mailing Address
First Line	:	26 HARVESTER AVE STE 104
Second Line	:
City	:	BATAVIA
State	:	NY
Zip	:	14020-3300
Country	:	US
Telephone Number	:	585-252-0030
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 HARVESTER AVE STE 104
Second Line	:
City	:	BATAVIA
State	:	NY
Zip	:	14020-3300
Country	:	US
Telephone Number	:	585-252-0030
Fax Number	:

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

Provider Enumeration Date	:	09/03/2021
Last Update Date	:	07/15/2022

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