Provider Demographics
NPI:1154503464
Name:ENGEL, MATTHEW (LCSW, CHT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ENGEL
Suffix:
Gender:M
Credentials:LCSW, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 SOUTH NOVATO BLVD #263
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-5032
Mailing Address - Country:US
Mailing Address - Phone:415-377-7533
Mailing Address - Fax:
Practice Address - Street 1:845 REICHERT AVE APT 1
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-4130
Practice Address - Country:US
Practice Address - Phone:415-377-7533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA241691041C0700X
MA1105411041C0700X
MA3653701041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08070OtherBLUE CROSS/BLUE SHIELD