Provider Demographics
NPI:1861173718
Name:NAHOUM, MATTHEW ROBIN (LCAT, ATR-BC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBIN
Last Name:NAHOUM
Suffix:
Gender:M
Credentials:LCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 S BROADWAY STE 2
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3198
Mailing Address - Country:US
Mailing Address - Phone:917-359-9343
Mailing Address - Fax:
Practice Address - Street 1:48 BURD ST STE 300
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3226
Practice Address - Country:US
Practice Address - Phone:917-960-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001903-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist