Provider Demographics
NPI:1083127583
Name:KUZMICH, MATTHEW ALEXANDER (LCSW)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALEXANDER
Last Name:KUZMICH
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4975 SE DIVISION ST APT 248
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1574
Mailing Address - Country:US
Mailing Address - Phone:408-398-9622
Mailing Address - Fax:
Practice Address - Street 1:4975 SE DIVISION ST APT 248
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-1574
Practice Address - Country:US
Practice Address - Phone:408-398-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALSCW957311041C0700X
ORL150751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical