Provider Demographics
NPI:1174896021
Name:MATTHEW D GEE, LCSW, PHD, LLC
Entity type:Organization
Organization Name:MATTHEW D GEE, LCSW, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:GEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-335-8744
Mailing Address - Street 1:363 ROUTE 111
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4756
Mailing Address - Country:US
Mailing Address - Phone:631-335-8744
Mailing Address - Fax:631-265-3205
Practice Address - Street 1:363 ROUTE 111
Practice Address - Street 2:SUITE 103
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4756
Practice Address - Country:US
Practice Address - Phone:631-335-8744
Practice Address - Fax:631-265-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051398-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty