Provider Demographics
NPI:1194123083
Name:STUKALIN, MATTHEW E (LCSW)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:E
Last Name:STUKALIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7635 113TH ST APT 3G
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6520
Mailing Address - Country:US
Mailing Address - Phone:347-306-0455
Mailing Address - Fax:
Practice Address - Street 1:135 WHITSON ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6853
Practice Address - Country:US
Practice Address - Phone:347-306-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0872871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical